Tuberculum meningioma with recovery of glaucoma-like visual field defects after chiasmal decompression: a case report

TL;DR

A woman with a brain tumor showed glaucoma-like vision loss, which improved after surgery, suggesting the tumor caused the visual defects.

Contribution

Demonstrates that chiasmal compression can mimic glaucoma and improve after decompression.

Findings

Glaucoma-like visual field defects resolved after chiasmal decompression despite no improvement in RNFL thinning.

Chiasmal compression can produce arcuate scotomas similar to glaucomatous changes.

Preperimetric glaucoma may appear advanced due to chiasmal compression and revert after decompression.

Abstract

To report a case of tuberculum meningioma with recovery of glaucoma-like visual field defects after chiasmal decompression.

A 39-year-old woman presenting with headache was found to have bilateral arcuate retinal nerve fiber layer (RNFL) thinning on optical coherence tomography (OCT) with a corresponding arcuate scotomas consistent with glaucomatous change. However a suprasellar tumor compressing the anterior chiasm from below was found on magnetic resonance imaging of the brain. After resection of the mass, which was diagnosed as meningothelial meningioma by the pathological examination, the glaucoma-like visual field defects resolved despite the RNFL thinning on the OCT showing no improvement.

Chiasmal compression may mimic glaucoma and produce arcuate scotoma rather than temporal visual field loss. There is a possibility that the development of chiasmal compression somehow converted preperimetric glaucoma into a more advanced form accompanied by visual field defects and that the glaucoma reverted to the preperimetric state after chiasmal decompression.

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