Chiasmal and/or Optic Nerve Apoplexy Due to Rupture of Vascular Malformation -Case Report-

Abstract

An 8-year-old boy presented with a rare case of optic nerve apoplexy caused by an arteriovenous malformation (AVM) manifesting as severe headache and blurred vision. Computed tomography (CT) showed a hyperdense suprasellar mass. Magnetic resonance (MR) imaging indicated a hematoma in the right optic nerve. MR angiography showed normal vessels. Right fronto-temporal craniotomy identified an aggregate of abnormal, nidus-like vessels adhering to the medial surface of the swollen right optic nerve and a drainer-like ectatic red vein. The diagnosis was probable AVM. To avoid optic nerve damage, the malformation was left intact. Two years later, the boy was readmitted with headache. CT showed bleeding, and angiography revealed feeder arteries and nidus in the suprasellar lesion. The diagnosis was optic nerve apoplexy due to AVM. His symptoms improved without intervention within days. He has not experienced any recurrence of the bleeding for 2 years.

Opticochiasmatic Apoplexy in a Five-Year-Old

“…Watchful waiting has been recommended in some cases of opticochiasmatic apoplexy as the symptoms may spontaneously resolve [4]. Others have recommended early intervention suggesting that it may improve outcomes [3,8].…”

“…Opticochiasmatic apoplexy has been reported in a few case reports and small series in association with arteriovenous malformations [1,2,3,4], cavernous malformations [5,6,7], optic nerve gliomas [7,8], and a pilocytic astrocytoma of the optic nerve [9]. Patients with suprasellar hemorrhage typically present with acute visual loss, but they have also presented with amblyopia [5], menstrual changes [7], proptosis [10,11,12], headaches [4,6,13], and mental status changes [2,5]. …”