Presentation
Reduced vision in the right eye with pale disc.
Patient Data
Tram-track-like calcification of the right optic nerve extending back through the orbital foramina and extending to the optic chiasma.
Case Discussion
The optic nerve calcification with tram track sign, is usually indicative of a meningioma originating from the nerve sheath, results from subdural growth, leading to a progressive decline in vision, papilledema, and optic atrophy. Calcifications are observed in 20-50% of cases. Additionally, abnormal enhancement of the optic sheath may occur.
Yet it is worth mentioning the other differential diagnosis for optic nerve sheath calcification, which could be metabolic because of disorder of calcium/phosphate metabolism or dystrophic secondary to hemorrhage or necrosis after trauma or idiopathic harmless calcification.
If it is symptomatic, it is recommended to do MRI with contrast to define any dural enhancement or soft tissue enhancement in case of meningioma which is difficult to characterize in CT because of the calcification.
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