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Ophthalmic Images
October 8, 2020

Hemorrhagic Papilledema Secondary to Craniopharyngioma

Author Affiliations
  • 1Neuro-Ophthalmology Service, Massachusetts Eye and Ear, Harvard Medical School, Boston
JAMA Ophthalmol. 2020;138(10):e200880. doi:10.1001/jamaophthalmol.2020.0880

A man in his 30s presented to an emergency department with intermittent nausea and vomiting, vision changes, and frontal and occipital headaches unresponsive to treatment for the past 2 months. He also reported a 6.8-kg unintentional weight loss during the same period. His best-corrected visual acuity was 20/20 OD and 20/25 OS. A dilated ophthalmoscopic examination revealed bilateral disc edema with peripapillary and retinal hemorrhages obscuring the margins and vessels and the left eye worse than the right eye, which reflected a rapid course of increasing intracranial pressure (Figure). Automated visual field testing revealed an incongruous right homonymous hemianopia with a left enlarged blind spot. A magnetic resonance image demonstrated a lobulated mass within the third ventricle and suprasellar region (Figure). Results of a biopsy of the mass were consistent with papillary craniopharyngioma. Pharmaceutical therapy was offered because the tumor was positive for BRAF V600E sequence variation.

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