Twenty-three cases of germinoma with optic nerve or optic chiasm involvement were reported. Patients ranged from ages 9 to 34, with 9 males, 10 females, and 4 cases without sex data. Nearly all presented with progressive vision loss and poor visual acuity (96%, n=22). Endocrine abnormalities were reported in 17 cases, commonly diabetes insipidus (88%, n=15) or hypopituitarism (70%, n=12), with 13 showing abnormalities prior to/at presentation. MRI demonstrated thickening or enhancement of the optic nerve or optic chiasm in all cases. Of 12 cases reporting suspected pathology, 25% (n=3) were thought to have optic neuritis.

Our 19-year-old male patient similarly presented with progressive vision loss in the right eye and visual acuity decreased to finger counting. He lacked preceding endocrine abnormalities; though hypopituitarism was diagnosed later. MRI revealed right optic nerve and chiasmal enhancement with thickening and enhancement of the infundibulum and hypothalamus. Treatment with high-dose corticosteroids for suspected optic neuritis yielded minimal improvement. Repeat imaging demonstrated an enlarging hypothalamic lesion extending into the optic nerves. Stereotactic biopsy confirmed germinoma.