NCO-07CASE REPORT: CARCINOMATOUS OPTIC NEUROPATHY

38 years old female presented with progressive double vision followed by decreased visual acuity in left eye to almost 20/400 and later right eye. Her initial MRI B was unremarkable. LP showed opening pressure of 60, WBC 2, protein 144, normal glucose. Fundoscopic examination did not reveal any papilloedema. Considering her progressive vision loss and double vision, EVD was placed with resolution of her double vision and very mild improvement in her visual acuity. After 2 days, VP shunt was placed but her visual acuity got worse afterwards. MRV brain showed possible venous sinus thrombosis left transverse, sigmoid and internal jugular vein. At this point she also started having progressive numbness/tingling and weakness in her lower extremities. CT abdomen showed colon mass so she had colon biopsy showing poorly differentiated adenocarcinoma. At this point she was transferred to our facility for further evaluation. MRI T and L spine showed spinal root enhancement, repeat LP showed protein 1501, WBC 3 and normal glucose. EMG showed early intraspinal process at multiple levels affecting the lumbar and cervical spinal roots. Colon biopsy was repeated and confirmed poorly differentiated adenocarcinoma. Her CA 125 was 447 so ovarian carcinoma was suspected. CONCLUSION: Opthalmoplegia in our patient was probably from ICP secondary to carcinomatous meningitis. Even with progressive vision loss, she did not have papilledema so retrobulbar optic neuropathy was suspected which was thought to be secondary to paraneoplastic syndrome.