Optic nerve glioma differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

Optic nerve glioma must be differentiated from other diseases that cause optic nerve enlargement such as optic nerve sheath meningioma, orbital pseudotumor, optic neuritis, orbital lymphomas, metastasis, fibrous dysplasia, paranasal mucocele, rhabdomyosarcoma, neurofibromatosis, perioptic haemorrhage, Erdheim-Chester disease, juvenile xanthogranuloma, medulloepithelioma, retinoblastoma, Krabbe disease, optic nerve and chiasm glioma such as germinoma and sarcoidosis, and optic chiasm glioma extending into the hypothalamus such as pituitary adenoma, craniopharyngioma, malignant astrocytoma, dermoid cyst, chordoma, colloid cyst, histiocytosis X, tuberculous granuloma, and hemangloendothelioma.

Differentiating Optic nerve glioma from other diseases

• The major differential diagnostic considerations when an enlarged optic nerve is identified on imaging are
  • inflammatory (neuritis, infection, or pseudotumor)
  • Neoplastic,
  • Result of increased intracranial pressure.
• Distinguishing inflammatory from neoplastic processes of the nerves is difficult because both may demonstrate optic-nerve enlargement with or without contrast enhancement.
• Clinical history can then be used to determine the underlying cause.
• Unilateral involvement, no pain on extra-ocular movement, no systemic inflammatory signs at around the onset of visual loss, no additional white-matter abnormality or recurrent visual symptoms during follow-up period might support a diagnosis of optic-nerve glioma rather than optic neuritis in childhood.
• Other tumorous conditions such as lymphoma or inflammatory pseudo-tumor may be ruled in the absence of a history of painful ophthalmoplegia or a rapid deterioration of symptoms during follow-up.

Differentiating Optic nerve glioma from other diseases
Optic nerve glioma	Hemangioma, Lymphoma, Rhabdomyosarcoma, Metastases (Neuroblastoma, Leukamia, Ewing’s sarcoma), Fibrous dysplasia, Paranasal mucocoele, Meningioma, Neurofibromatosis
Optic nerve and chiasm glioma	Germinoma, Sarcoidosis
Optic chiasm glioma extending into the hypothalamus	Pituitary adenoma, Craniopharyngioma, Malignant astrocytoma Dermoid cyst, Chordoma, Colloid cyst, Fibrous dyplasia, Sarcoidosis, Histiocytosis X, Tuberculous granuloma, Hemangloendothelioma