Cerebral high-grade astrocytomas typically result in poor outcomes for patients because their invasive nature makes resection difficult and because their resistance to chemoradiation usually leads to local recurrence. Herein, we report a case of acute vision loss with a dramatic presentation due to a recurrent cerebral malignant glioma.
A woman in her 40s with a recurrent cerebral malignant glioma in the left frontal lobe presented with blurred vision in the right eye. At presentation, she was undergoing treatment with systemic steroids, durvalumab (a PD-L1 inhibitor), and bevacizumab. Her initial examination revealed a visual acuity of 20/25 OU. The right eye field was full, but there was a right-sided relative afferent pupillary defect, an unremarkable anterior segment, and mild swelling of the optic disc. The left eye had a normal fundus and visual function. Magnetic resonance imaging of the brain revealed parenchymal disease progression, with enlargement and enhancement of the right optic nerve (Figure 1).
Liu TYA, Ediriwickrema LS, Vizcaino MA, Wenick A, Miller NR. Optic Nerve Infiltration and Vitreous Seeding by a Cerebral Glioblastoma. JAMA Ophthalmol. 2017;135(4):400-401. doi:10.1001/jamaophthalmol.2016.5835