Optic nerve glioma physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]
Overview
Common physical examination findings of optic nerve glioma include nystagmus, strabismus, proptosis, visual impairment, afferent pupillary defect, edema and/or pallor of optic disc, torticollis and deficits of cranial nerve II.
Physical Examination
Eyes
- Nystagmus may be present.[1][2]
- Strabismus
- Visual impairment
- Proptosis
- Visual field tests
- Afferent pupillary defect
- Fundoscopic examination may show pallor and/or edema of the optic disc due to atrophy. Initially, optic nerve head is swollen but subsequently it becomes atrophic. Central retinal vein occlusion and optociliary collaterals may occasionally be seen.
- On slit-lamp examination iris hamartomas (Lisch nodules) may be identified in optic nerve glioma patients with associated NF-1.
Head
- Torticollis may be present[3]
Neurological
- Mental status may be altered if obstructive hydrocephalus is present.
- There are deficits in cranial nerves II- Involuntary eyeball movement and loss of peripheral vision in one or both eyes.
Skin
- Café-au-lait spots or hyperpigmented macules may be present in patients with optic pathway glioma associated with NF-1.
- Axillary or inguinal freckles may be present in patients with optic nerve glioma associated with NF-1.
References
- ↑ Lavery MA, O'Neill JF, Chu FC, Martyn LJ (1984). "Acquired nystagmus in early childhood: a presenting sign of intracranial tumor". Ophthalmology. 91 (5): 425–53. PMID 6739045.
- ↑ Arnoldi KA, Tychsen L (1995). "Prevalence of intracranial lesions in children initially diagnosed with disconjugate nystagmus (spasmus nutans)". J Pediatr Ophthalmol Strabismus. 32 (5): 296–301. PMID 8531033.
- ↑ Koenig SB, Naidich TP, Zaparackas Z (1982). "Optic glioma masquerading as spasmus nutans". J Pediatr Ophthalmol Strabismus. 19 (1): 20–4. PMID 7069562.