MANAGEMENT OF RETROBULBAR NEURITIS DUE TO
ASTROCYTOMA
Mas Putrawati T, AA; Suryathi, Ari Suryathi,NM; Golden, Nyoman
Ophthalmology Department, Udayana University Faculty of Medicine, Sanglah Hospital, Denpasar
Optic nerve inflammation behind bulbus oculi until brain is called retrobulbar neuritis. Demyelinisation process and viral infection is often reported as major cause of this case. Tumor secondarily to optic neuritis have been reported only in 3%.
Purpose : This case report focuses on management of retrobulbar neuritis due to astrocytoma with ONTT, tumor resection and pathology anatomy examination.
INTRODUCTION
Male, 17 years old, presented with sudden visual loss since two days duration. History of having difficulties to concentrate and behavioural changes. Right eye visual acuity was NLP with relative afferent pupillary defect, and the left eye was 6/20. Low grade astrocytoma in right and left frontal lobe was suspected from MRI examination. Optic Neuritis Treatment Trial, tumor resection with pathology anatomy examination were done. Pathology anatomy result support the low grade astrocytoma diagnosis. Visual acuity improvement to 4/60 in right eye and 6/6 in left eye after tumor resection.
CASE DESCRIPTION
1. Alfredo Contss. Inflammation Radical Causes of cancer. National Revission . New York: 2010. p. 276–285.
2. American Academy of Ophthalmology staff. Neuro Ophthalmology. Basic and Clinical Science Course. Section 5. San Fransisco: 2011-2012. p.144-9, 305-8
3. Gill, J.S.; Zhu, X.; Moore, M.J.; Yaszemski, M.J.; Windebank, A.J. Effects of NFkappaB Oligonucleotides Released from Biodegradable Polymer Microparticles on a Glioblastomacell Line. Biomaterials: 2012. p. 2773–278
4. Nagai, S; Washiyama, K; Kurimoto, M.; Takaku, A.; Endo, S.; Kumanishi, T. Aberrant Nuclear factor-kappaB Activity and Its Participation in the Growth of Human Malignant Astrocytoma. Journal of Neurosurgery. 2012. p. 909–917
5. Sadun Lin. A Suprasellar Meningioma Simulating Atypical Retrobulbar Optic Neuritis. J. Chin Med Assoc, 2010. p. 689-692
REFERENCES
DISCUSSION
ONTT is the management of retrobulbar neuritis. Astrocytoma produces some inflammatory mediators and thrive in inflammed environment. Inflammatory mediators assessment of the resected astrocytoma are better done to prove the inflammation process.
Fig 1. Normal right and left fundus
Fig 2. Head MRI showing tumor in frontal lobe (arrow)
Fig 3. Frontal parenchymal edema & subdural hematome
(Post tumor resection)
Fig 4. Tumor morphology with gemistocyte cells and
perivascular lymphocyte foci (arrow)
Fig 6. Normal NFL (RE) & superior and inferior NFL thinning (LE) Fig 5. Normal visual field (RE) & central scotoma (LE)
