Abstract Details

Title The Diagnostic Odyssey of Anterior Chiasmal Cavernous Hemangioma

Topic Neuro-oncology

Presentation(s) Neuro-oncology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 036

Objective

To highlight the importance of having a broad differential considerations when evaluation a case of chiasmal lesion.

Background Cavernous hemangioma of chiasm, optic nerves or tracts comprise less than 1% of cavernous malformations. To date, less than 100 cases were described in the literature, and the majority of patients initially received alternative diagnosis. Thus, it is imperative for the clinician to recognize this entity in a timely manner as the prompt surgical innervation could lead to a symptomatic improvement. We report a case of the anterior left cavernous hemangioma in a patient who presented with visual loss.

Design/Methods Case study

Results A 64-year-old right-handed man presented with a subacute onset of progressive decrease in visual acuity and bitemporal visual field deficits without systemic symptoms. Examination showed a left afferent pupillary defect, decreased visual acuity and incongruent bitemporal hemianopia. Imaging studies identified enhancement of the cisternal segment of the left optic nerve and the adjacent optic chiasm. Based on the clinical data and examination findings, optic nerve glioma was initially considered to be the most likely diagnosis. Alternative etiologies included inflammatory optic neuropathies, infections and vascular lesions. Comprehensive laboratory workup was unremarkable. Thus, it was surprising to find on repeat brain imaging an interval hemorrhage within the left optic chiasm lesion suspicious for cavernous malformation. Angiogram of the brain confirmed the diagnosis and identified additional numerous foci of blooming likely representing multiple cavernous malformations. He subsequently underwent a left pterional craniotomy for cavernous resection. Final pathology showed cavernous hemangioma.

Conclusions This case highlights challenges faced with establishing the diagnosis of chiasmal cavernous hemangioma due to the constellation of symptoms and imaging findings that resemble neoplastic or inflammatory conditions. However, having a high index of suspicion for an alternative etiology could help to expedite the diagnosis and management.

Authors/Disclosures
Maya Hrachova, DO (Home) PRESENTER	Dr. Hrachova has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for SpringWorks Therapeutics.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Bernard Bendok, MD (Mayo Clinic)	No disclosure on file
Maciej M. Mrugala, MD, PhD, MPH, FAAN (Mayo Clinic)	Dr. Mrugala has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Veevo Biomedicines Inc. Dr. Mrugala has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arbor Pharmaceuticals. Dr. Mrugala has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astra-Zeneca. Dr. Mrugala has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Mrugala has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Kyiatec . The institution of Dr. Mrugala has received research support from Arbor Pharmaceuticals. Dr. Mrugala has a non-compensated relationship as a Program Director with Society for Neuro-Oncology that is relevant to AAN interests or activities.

��ɫ��

��ɫ��