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Vol. 25. Num. 3.May - June 2014
Pages 99-148
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Vol. 25. Num. 3.May - June 2014
Pages 99-148
Case Report
DOI: 10.1016/j.neucir.2013.11.001
Chiasmal haemorrhage secondary to glioma with unusual MRI appearance
Hemorragia quiasmática secundaria a glioma con apariencia inusual en RM
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Ignacio Arresea,??
Corresponding author
iarrese14@yahoo.es

Corresponding author.
, Rosario Sarabiaa, Tomás Zamorab
a Department of Neurosurgery, Hospital Universitario Río Hortega, Valladolid, Spain
b Department of Pathology, Hospital Universitario Río Hortega, Valladolid, Spain
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Abstract
Objective

To report a unique case of haemorrhagic presentation of a chiasmal and optic tract glioma (OPG) appearing as an extra-axial lesion on MRI scans.

Case report

A 30-year-old female with a preoperative radiological diagnosis of dermoid cyst was operated. No lesion was found in the chiasmal or carotid cisterns within the operative field. The right posterolateral corner of the chiasma and the beginning of the right optic tract appeared swollen. The area was incised and a haemorrhagic fluid poured through the opening. Several samples were taken and the pathological diagnosis was of pilocytic glioma.

Conclusions

We present a unique case of chiasmal bleeding into the optic pathway secondary to an optic glioma which radiologically mimicked an intracisternal cyst. In similar cases, rapid clinical evolution of the symptoms may be vital for the differential diagnosis. Surgery is warranted to prevent permanent damage to the visual pathway.

Keywords:
Opticochiasmatic apoplexy
Glioma
Haemorrhage
Dermoid cyst
Resumen
Objetivo

Reportamos un caso de presentación hemorrágica de un astrocitoma pilocítico quiasmático (APQ) que aparentaba una masa extraaxial en RM.

Caso clínico

Mujer de 30 años que fue intervenida con diagnóstico preoperatorio de quiste dermoide pero que, en el campo quirúrgico, no se encontró lesión alguna en las cisternas quiasmática ni carotídea. A nivel del borde posterolateral del quiasma se apreciaba una zona enrojecida y abombada que, tras su incisión, demostró la presencia de hemorragia quiasmática. Las muestras tomadas en esta zona fueron diagnosticadas anatomopatológicamente de astrocitoma pilocítico.

Conclusiones

Presentamos un caso excepcional de sangrado quiasmático de un APQ que imita radiológicamente una lesión extraaxial. En casos similares, la rápida evolución clínica puede ser la clave para el diagnóstico deferencial. La cirugía está justificada a fin de evitar daños visuales permanentes.

Palabras clave:
Apoplegía optoquiasmática
Glioma
Hemorragia
Quiste dermoide

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