Presentation
Partial epilepsy.
Patient Data
Bilateral and relatively symmetrical enlargement of the prechiasmatic portion of the optic nerves, as well as more posterior involvement of the optic chiasma, optic tracts, and left thalamus. The lesion appears isointense to the gray matter on T1WI, hyperintense on T2WI and FLAIR, with a small central area of heterogeneous enhancement on postcontrast sequences. The DWI shows an intermediate signal. No cystic changes within the lesion.
Case Discussion
The distribution and MRI features of the lesion are characteristic of optic pathway glioma, stage 3 according to Dodge classification. This is most likely a sporadic case (the patient had no other manifestations of NF1).
Additional contributor: A. Ramdani, MD