Makindo Medical Notes

A rare neurological condition characterized by a combination of optic atrophy in one eye and papilloedema in the other.

About

• Ipsilateral optic atrophy: Occurs due to direct compression of the optic nerve on the side of the lesion.
• Contralateral papilloedema: Results from increased intracranial pressure (ICP) affecting the opposite eye.

Cause

• Olfactory groove meningioma: A tumor in the region of the olfactory groove, often compressing the optic nerve.
• Medial third sphenoid wing meningioma: Another location where a meningioma can cause compression leading to Foster Kennedy Syndrome.

Clinical Investigations

• Ophthalmologic Examination:
  • Fundoscopy to assess optic atrophy in the affected eye and papilloedema in the contralateral eye.
  • Visual acuity and visual field testing to evaluate the extent of optic nerve involvement.
• Imaging:
  • MRI with contrast: Preferred imaging technique to detect intracranial masses, such as meningiomas, near the olfactory groove or sphenoid wing.
  • CT Scan: Alternative imaging option if MRI is unavailable; helps in identifying bone involvement and tumor calcification.
• Intracranial Pressure (ICP) Monitoring: Recommended if there are signs of raised ICP. Helps in assessing the severity of papilloedema and risk of intracranial complications.
• Neurological Examination: Comprehensive exam to assess for other neurological deficits that may indicate the extent and location of the lesion.

Management

• Neurosurgical Intervention:
  • Surgical Resection: Removal of the meningioma or other causative tumor to relieve compression on the optic nerve and reduce ICP.
  • Transcranial or Endoscopic Approaches: Chosen based on tumor location, size, and surgical access; endoscopic approaches may reduce recovery time and complications.
• ICP Management:
  • Medications such as mannitol and corticosteroids may help reduce cerebral edema and lower ICP before surgery.
  • Positioning and fluid management to optimize ICP control in the perioperative period.
• Monitoring and Follow-Up:
  • Regular follow-up with ophthalmologic and neurologic exams to monitor visual recovery and detect any recurrence.
  • Postoperative MRI imaging to confirm complete tumor resection and assess for any residual mass effect.

Early intervention is crucial to prevent permanent visual loss. Multidisciplinary care involving neurology, neurosurgery, and ophthalmology is essential for optimal management and recovery.