Occipital Lobe Tumor

Abstract

A 72-year-old female presented with complaints of blurred vision in both eyes for 1 year. She had a past medical history of left occipital meningioma, which was treated with radiotherapy. Beginning 2 months prior, the patient reported experiencing sustained headaches and dizziness. The headaches were more prominent over the left side. She denied any traumatic injury or bouts of fever recently. Two weeks ago, her vision got notably worse, and her headaches progressed to intolerable 1 week ago. She visited our clinic for a thorough ophthalmoscopic examination. Her corrected visual acuity was 6/10 in the right eye and 6/12 in the left. Intraocular pressures and anterior segments were normal. Fundoscopic examination showed tessellated changes in both eyes (Fig. 18.1). Optic coherence tomography (OCT) showed a normal thickness of the peripapillary retinal nerve fiber layer (RNFL) in both eyes. In addition, the macular ganglion cell-inner plexiform layer (GC-IPL) was normal (Fig. 18.2). A visual field examination revealed right inferior homonymous quadrantanopia in both eyes (Fig. 18.3). MRI showed an extra-axial space-occupying lesion in the left occipital area with perifocal edema, mixed iso- and low signals on T1WI, mixed iso- and high signals on T2WI, heterogeneous enhancement, and focal “diffusion-restriction”; with these findings, meningioma, especially the atypical or malignant types, should be considered (Fig. 18.4). The patient underwent a craniotomy, and her pathological report showed an anaplastic meningioma with sheetlike growth, increased cellularity, extensive necrosis, and increased mitotic activity (>20/10 hpf in most active areas).