A Visual Field Defect in a Patient With History of Seizures

Jonathan J. Go; Rod Foroozan, MD

Disclosures

October 09, 2018

Case Diagnosis

Meningiomas are common non-glial central nervous system (CNS) tumors that often appear as lobular, extra-axial masses with well-circumscribed margins. T1-weighted MRI sequences usually show isointensity to slight hypointensity relative to grey matter and contrast enhancement.[1] The findings of this patient's axial T1 post-contrast MRI revealed that the mass was intra-axial, which implies that a meningioma is an unlikely diagnosis.

Ependymomas are primary CNS tumors originating from ependymal cells in the ventricular walls and spinal cord.[2] Intracranial ependymomas often show low T1 signal intensity relative to grey and white matter.[3] While the MRI image showed enlargement of the lateral ventricle, occipital lobe involvement was also noted, excluding an ependymal cell origin.

Cavernous hemangiomas (cavernomas) are vascular malformations within the parenchyma of the CNS, often presenting between the third and fifth decades of life with headaches, seizures, or focal neurologic deficits. MRI typically reveals a "mulberry" or "popcorn" appearance surrounded by a hypointense, peripheral ring.[4] This patient's MRI did not show these characteristic findings, reducing the likelihood of a cavernoma.

A porencephalic cyst is a rare CNS disorder defined as an intracranial cyst that contains cerebrospinal fluid and smooth walls lined by gliotic or spongiotic white matter.[5] MRI typically reveals a brain cyst with a well-defined border, with a white matter lining with or without gliosis. Low cerebrospinal fluid signal intensity is present in T1. The findings of this patient's MRI are consistent with these characteristics.

Clinical Course

The patient was instructed to follow up with her ophthalmologist regularly and to return in 3 months to reassess her vision. Three months later, the patient reported no changes in visual fields and no new visual complaints. Her ophthalmic examination findings were unchanged.

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