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Título

UNILATERAL PAINLESS VISION LOSS AS A PRIMARY MANIFESTATION OF FOSTER KENNEDY SYNDROME

Introdução

Foster Kennedy Syndrome (FKS) is a rare neuro-ophthalmological condition linked to frontal lobe neoplasms, commonly meningiomas. Clinical symptoms include anosmia, headaches, and focal neurological deficits. Neuroimaging is crucial for diagnosis. This report highlights a challenging case of FKS where acute visual loss was the sole symptom, associated with Bartonella and Toxocara infections.

Métodos

This is a retrospective, observational, and descriptive case report of a patient with FKS. Data was obtained through outpatient follow-up at the Instituto da Visão do Espírito Santo (IVES), between 2022 and 2023.

Resultados

Woman, 36 years old, presented with sudden, acute, and painless loss of visual acuity (VA) in the left eye (OS) persisting for 18 months. Denied headaches, focal neurological deficits or anosmia. Fundoscopy revealed severe temporal pallor of the optic nerve (ON) with serous retinal detachments and granulomatous lesion in the inferior temporal macular region of the OS (Fig. 1), with no abnormalities in the right eye (OD). Optical coherence tomography (OCT) exposed a lesion in the retinal pigment epithelium and diffuse chorioretinal granulomatous inflammation in the OS (Fig. 2). Serological tests were positive for toxocariasis and bartonellosis, and the patient was treated with Albendazole and Doxycycline. Four months after treatment completion, the patient reported progressive proptosis in the OS, and fundoscopy showed papillary edema in the OD. Non-contrast cranial computed tomography revealed a 6.0x6.4x6.3 cm mass in the sphenoid bone, suggestive of meningioma (Fig. 3). The mass exerted compressive effects on the optic chiasm, with greater involvement on the left side. After the diagnosis, frontotemporal craniotomy was performed and the tumor was partially resected. At a follow-up appointment after 2 months, the patient reported complete blindness in both eyes. Post-surgical magnetic resonance imaging revealed residual tumor measuring 6.8x4.9x3.7 cm. Consistent with the reported case, most FKS cases described in the literature are associated with meningiomas, often resulting in visual loss due to ON compression.

Conclusões

FKS is a rare neuro-ophthalmological presentation (1% of intracranial masses) characterized by ipsilateral optic nerve atrophy and contralateral papilledema due to neoplastic compression. The mentioned case is atypical, emphasizing the convergence of morbidities. Visual impairment from compressive optic neuropathy demands prompt diagnosis and treatment.

Palavras Chave

Optic Nerve Diseases; Meningioma; Neuroimaging; Blindness; Case Reports

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