Presentation
Progressive left eye vision loss
Patient Data
Coronal T1 and STIR sequences display asymmetric enlargement of the left optic nerve. On axial T1 post contrast with fat supression, there is a lobular extra-axial mass with avid enhancement centered at the left tuberculum sella. The mass extends along the left optic nerve sheath giving a characteristic "tram-track" appearance. On coronal T1 post contrast with fat suppression, we see circumferential enhancement of the optic nerve sheath with sparing of the centrally located optic nerve. Features are consistent with a meningioma of the optic nerve sheath.
Case Discussion
This is a case of an optic nerve sheath meningioma proven pathologically following surgical resection. This case illustrates the classic "tram-track" and "donut" appearance on axial and coronal post contrast imaging, respectively.
CO-AUTHOR:
Daniel P. Gewolb, MD
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