Scribd Logo
Upload

Welcome to Scribd!

  • 54 views

    Intracranial Tumors: An Ophthalmic Perspective: DR M Hemanandini, DR P Sumathi, DR P A Kochami

    Uploaded by

    wolfang2001
    The document summarizes a study on the ophthalmic manifestations of patients presenting with brain tumors. It found that headache was the most common symptom reported, while decreased vision and papilledema were the most common ocular symptom and sign, respectively. Meningiomas were the most prevalent brain tumor identified. The study concluded that ophthalmic signs play an important role in early diagnosis of brain tumors, allowing for timely localization and management. Careful ophthalmic evaluation of patients presenting with symptoms like headache and vision changes can help detect underlying brain tumors.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Intracranial Tumors: An Ophthalmic Perspective: DR M Hemanandini, DR P Sumathi, DR P A Kochami

    Uploaded by

    wolfang2001
    54 views3 pages
    The document summarizes a study on the ophthalmic manifestations of patients presenting with brain tumors. It found that headache was the most common symptom reported, while decreased vision and papilledema were the most common ocular symptom and sign, respectively. Meningiomas were the most prevalent brain tumor identified. The study concluded that ophthalmic signs play an important role in early diagnosis of brain tumors, allowing for timely localization and management. Careful ophthalmic evaluation of patients presenting with symptoms like headache and vision changes can help detect underlying brain tumors.

    Original Description:

    EYE

    Original Title

    l 1506126062

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document summarizes a study on the ophthalmic manifestations of patients presenting with brain tumors. It found that headache was the most common symptom reported, while decreased vision and papilledema were the most common ocular symptom and sign, respectively. Meningiomas were the most prevalent brain tumor identified. The study concluded that ophthalmic signs play an important role in early diagnosis of brain tumors, allowing for timely localization and management. Careful ophthalmic evaluation of patients presenting with symptoms like headache and vision changes can help detect underlying brain tumors.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    54 views3 pages

    Intracranial Tumors: An Ophthalmic Perspective: DR M Hemanandini, DR P Sumathi, DR P A Kochami

    Uploaded by

    wolfang2001
    The document summarizes a study on the ophthalmic manifestations of patients presenting with brain tumors. It found that headache was the most common symptom reported, while decreased vision and papilledema were the most common ocular symptom and sign, respectively. Meningiomas were the most prevalent brain tumor identified. The study concluded that ophthalmic signs play an important role in early diagnosis of brain tumors, allowing for timely localization and management. Careful ophthalmic evaluation of patients presenting with symptoms like headache and vision changes can help detect underlying brain tumors.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)

    e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 15, Issue 6 Ver. XII (June 2016), PP 60-62
    www.iosrjournals.org

    Intracranial Tumors: An Ophthalmic Perspective


    Dr M Hemanandini1, Dr P Sumathi2, Dr P A Kochami3
    1

    Head Of The Department ,Department Of Ophthalmology, Coimbatore Medical College Hospital,


    Coimbatore, Tamilnadu
    2
    assistant Professor, Department Of Ophthalmology, Coimbatore Medical College Hospital,
    Coimbatore, Tamilnadu
    3
    resident, Department Of Ophthalmology, Coimbatore Medical College Hospital, Coimbatore, Tamilnadu

    Abstract
    Aim: This study was aimed at determining the ophthalmic manifestations of patients presenting with brain
    tumors in a tertiary care centre
    Materials and Methods: A prospective crossectional review of patients with brain tumors in a tertiary care
    centre in Tamilnadu was conducted between Nov 2015 to April 2016.The study included 25 CT /MRI proven
    cases of Intracranial space occupying lesions who underwent detailed ocular, neurological and systemic
    examination.
    Results: Out of 25 cases there were 9 males (36%) and 16 females(64%) and the mean age was 4025 years.
    Headache(72%) was the common symptom followed by decreased vision(60%).Various Ophthalmic
    manifestations included papilloedema ,diplopia ,defective vision, proptosis and optic atrophy.
    Meningioma(32%) followed by CP angle tumor(20%) were the most common brain tumors encountered.
    Conclusion: Ophthalmic signs and symptoms form a major part of presentation in patients with intracranial
    tumors. By careful ophthalmic evaluation, early diagnosis of Intracranial space occupying lesions could be
    possible thereby allowing localisation and early management of these tumors .
    Keywords: Intracranial tumors, ophthalmic manifestation, headache

    I. Introduction
    Ocular features may be the earliest manifestation of intracranial tumors which help us to diagnose the
    disease earlier and to decrease the morbidity and mortality of the patient. Intracranial tumors expand in volume
    and replace normal neural tissues leading to an increase in intracranial pressure. Ocular features could result
    from their effect on the visual pathway, ocular nerves and orbito-ocular tissues. Ocular symptoms of raised ICP
    are deviation of eye, diplopia and diminution of vision (DOV) depending upon the area of brain involved .
    Ocular signs include nystagmus,papilloedema, optic atrophy ,cranial nerve palsies with abducent nerve palsy
    being common and scotoma. In patients with Intracranial space occupying lesions ocular features may be seen
    much earlier than general signs. These signs have immense localizing importance .More than 50 percent of these
    patients present to an ophthalmologist initially. Hence in cases of intracranial space occupying lesions,
    ophthalmologists play a vital role in early diagnosis and proper referral. The purpose of this study was to assess
    the types of intracranial tumors that caused impairment of vision, and thereby establish a relationship between
    the various ocular effects caused by the intracranial tumors, aiding their localisation.

    II. Materials And Methods


    A prospective cross sectional study was conducted in a tertiary care centre in Tamilnadu from
    November 2015 to april 2016 on 25 patients diagnosed with intracranial tumors visiting ophthalmology and
    neurosurgery departments. Patients who were uncooperative on account of deteriorating general conditions,
    patients with history of previous head injury, cases of demyelinating diseases were excluded from the study. All
    the patients underwent detailed general and neurological examination in addition to CT scan and MRI .
    Complete ocular examination was done. Distant and near visual acuity of both eyes were recorded. Any
    abnormality in head posture that might be assumed to overcome diplopia was noted. The palpebral apertures
    were compared and to rule out lid retraction or lagophthalmos. Conjuctiva ,cornea and anterior chamber were
    examined. Pupils were assessed in terms of size, reactivity to light and any abnormal reactions. Uniocular and
    binocular eye movements were tested separately. Corneal sensations in both eyes were tested. Fundus
    examination of both eyes was done to find out any papilledema and optic atrophy. Cases of proptosis were
    evaluated thoroughly and local causes were ruled out. Detailed examination of cases presented with ptosis was
    done.. In cases of diplopia, chartings were done and charts were analysed.

    DOI: 10.9790/0853-1506126062

    www.iosrjournals.org

    60 | Page

    Intracranial Tumors: An Ophthalmic Perspective


    III. Results
    Age Distribution
    The age of patients ranged from 15- 65 years. The maximum incidence in our study was between 35 to
    55yrs of age. This was comparable with other studies by Helen OO et al, which showed a 43.2% % incidence
    in36-55 age group.[1]
    AGE GROUP
    15-35 YRS
    35-55 YRS
    ABOVE 55 YRS

    PERCENTAGE
    12%
    56%
    32%

    100
    50
    0
    AGE DISTRIBUTION

    Sex Distribution
    Our study showed a female preponderance of 64%.This was comparable with other studies by SefiYurdakul N.[7]

    Females
    Males

    Symptoms And Signs


    The most common systemic presenting complaint was Headache(72%). Diminution of Vision (60%)
    was the most common ocular presenting symptom.[7]Many patients presented with more than one symptom.
    Among the signs papilloedema (48%) was the most common ocular sign followed by Proptosis (4%), optic
    atrophy (7%) and Nystagmus (3%). Pupillary defect was seen in 24% of cases. Among nerve palsies,VI Cranial
    nerve palsy was recorded in 28% cases followed by VII cranial nerve palsy in 20% cases.

    Distribution Of Icsol
    In our study meningioma(32%) was the most common intraocular tumor encountered. This was
    comparable with other studies.[3]The other tumors encountered were CP angle tumor(20%), pituitary
    tumor(16%), astrocytoma(12%), cerebellar tumor(8%), ependymoma(8%) and craniopharyngioma(4%).
    TUMOR TYPE
    Meningioma
    CP angle tumor
    Pituitary tumor
    Astrocytoma

    DOI: 10.9790/0853-1506126062

    PERCENTAGE
    32%
    20%
    16%
    12%

    www.iosrjournals.org

    61 | Page

    Intracranial Tumors: An Ophthalmic Perspective


    Cerebellar tumor
    Ependymoma
    Craniopharyngioma

    8%
    8%
    4%

    Visual Acuity
    In 15 cases visual acuity was in the range of 6/6-6/12. In 8 patients visual acuity ranged between 6/186/36 and in 2 patients it was finger counting at 1 metre distance
    VISUAL ACUITY
    6/6-6/12
    6/18-6/36
    FC at 1m

    NO OF CASES
    15
    8
    2

    Visual Field
    Visual field defects were noted in 32% of cases. Blind spot enlargement was the most commonest.
    Bitemporal hemianopia was seen in cases of craniopharyngioma.

    IV. Discussion
    In the present study majority of cases were detected in the 35-55 age group. Our study shows a female
    sex preponderance which is comparable with other studies by Sefi-Yurdakul N.[7] Headache, seizure, cranial
    nerve palsies and papilloedema have been reported to be the most common signs and symptoms of intracranial
    tumors. Site of Intracranial space occupying lesion can be correlated with the ocular manifestation. Most of the
    patient presented with headache followed by defective vision. Hence patients presenting with these symptoms
    should be examined carefully. Papilloedema was the most common sign. Most common Intracranial space
    occupying lesion was meningioma followed by CP angle tumors. Sixth cranial nerve followed by seventh
    cranial nerve were involved commonly.

    V. Conclusion
    Ocular manifestations can occur very frequently in Intracranial space occupying lesion. These occur
    with increasing frequency in most of but not all intracranial tumors, thus making these patients seek early
    medical attention and most often help in localizing the lesion.. Early diagnosis and proper referral hence plays a
    vital role in the management and outcome of these tumors.

    References
    [1].
    [2].
    [3].
    [4].
    [5].
    [6].
    [7].
    [8].
    [9].

    Helen OO, Oluwole KE, Folasade A, Kayode A, Adeyoyin KM, Abiodun AA, Oluremi OS, Odunmorayo AA, Olukemi AB:
    Ophthalmic manifestations in patients with intracranial tumours: African Journal of Neurological Science. 2009; 28(1):53-9.
    Wadud SA, Ahmed S, Choudhury N, Chowdhury D: Evaluation of ophthalmic manifestations in patients with intracranial tumours:
    Mymensingh Medical Journal. 2014; 23(2):268-71.
    Masaya-anon P, Lorpattanakasem J: Intracranial Tumors Affecting Visual System: 5-Year Review in Prasat Neurological Institute:
    Journal of the Medical Association of Thailand 2008; 91 (4):515-19.
    Kitthaweesin K, Ployprasith C. Ocular manifestations of suprasellar tumors. J Med Assoc Thai.2008;91(5):711715.
    Margalit N, Barkay G, Kesler A. Delay in diagnosis of meningiomas involving the optic apparatus: conclusions and guidelines for
    early imaging based on our experience in 100 patients. Harefuah.2013;152(3):135138.
    Cheour M, Mazlout H, Agrebi S, Falfoul Y, Chakroun I, Lajmi H, Kraiem A. Compressive optic neuropathy secondary to a
    pituitary macroadenoma. J Fr Ophthalmol. 2013;36(6):e101104.
    Sefi-Yurdakul N. Visual findings as primary manifestations in patients with intracranial tumors. Int J Ophthalmol. 2015 Aug
    18;8(4):800-3.
    Wilne SH, Ferris RC, Nathwani A, Kennedy CR. The presenting features of brain tumours a review
    of 200 cases Arch Dis Child 2006; 91(6):5026.

    DOI: 10.9790/0853-1506126062

    www.iosrjournals.org

    62 | Page

    You might also like