Leptomeningeal Carcinomatosis with Delayed Ocular Manifestations

Acute Bilateral Vision Loss Following Unilateral Optic Nerve Sheath Fenestration

Optic nerve sheath fenestration (ONSF) is a surgical technique commonly and effectively employed in the treatment of recalcitrant, vision-threatening papilledema. Unilateral blindness, a known risk of unilateral ONSF widely cited with 1%-2% incidence. In this case, a 58-year-old patient who presented symptomatic with bilateral hemorrhagic papilledema unresponsive to medical therapy underwent uneventful unilateral ONSF via standard superomedial eyelid crease incision. The patient presented postoperatively with severe bilateral vision loss. Workup revealed widespread metastatic malignant disease involving the optic chiasm and optic nerve sheath.

Visual loss as the initial manifestation of an ignored disseminated prostate cancer: A case report

Purpose

To present a rare case of advanced disseminated prostate cancer with bilateral visual loss as the initial manifestation of the disease.

Observations

A 55-year-old man referring progressive visual blurring for the last 6 months and painless severe bilateral visual loss in the last 7 days prior to our consultation, associated with a bilateral optic disc swelling and leptomeningeal metastases from a previously ignored prostate carcinoma is presented. Rapid improvement of visual acuity and involution of leptomeningeal metastasis was observed after initiation of the specific oncologic treatment.

Conclusions and importance

Bilateral visual loss may be the initial manifestation of leptomeningeal carcinomatosis from an ignored prostate cancer. Prompt diagnosis is crucial in order to improve the quality of life of a critically ill patient with a disseminated prostate cancer.