Presentation
Decreased vision.
Patient Data
Symmetrical enlargement of the prechiasmatic portion of the optic nerves with a soft tissue mass of the optic chiasma extending along the optic tracts, and left optic radiation to the thalamus. The lesion appears isointense to the grey matter on T1, hyperintense on T2 and FLAIR, with no significant enhancement on postcontrast sequences. The DWI shows an intermediate signal. No hemorrhagic or cystic component within the lesion.
Case Discussion
The MRI features and the distribution of the lesion are highly suggestive 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).