Candanedo Carlos, Moscovici Samuel, Kruger Joshua M, Mizrachi Cezar J, Eliahou Ruth, Spektor Sergey
Neurosurgery, Hadassah-Hebrew University Medical Center.
Ophthalmology, Hadassah-Hebrew University Medical Center.
Cureus. 2017 Nov 20;9(11):e1862. doi: 10.7759/cureus.1862.
Bilateral papilledema secondary to obstructive or communicating hydrocephalus in patients with vestibular schwannomas is a known presentation; however, papilledema in the absence of hydrocephalus is rarely reported and its mechanism is poorly understood. We report a case of a 20-year-old woman presenting with visual deterioration and bilateral papilledema on fundoscopy. Magnetic resonance imaging (MRI) revealed a giant vestibular schwannoma with no sign of hydrocephalus. The only imaging evidence of increased pressure on preoperative imaging studies was seen on a T2-weighted MRI, where there was subtle dilatation of the arachnoid space of the optic sleeve. We presume that this patient developed papilledema by some mechanism not connected to hydrocephalus. In a young patient, papilledema may be a sign preceding hydrocephalus, or she may have had pseudotumor cerebri concomitant with her vestibular schwannoma. In either case, removal of the vestibular schwannoma solved the problem. She had complete visual recovery, irrespective of the mechanism.
前庭神经鞘瘤患者因梗阻性或交通性脑积水继发双侧视乳头水肿是一种已知的表现；然而，在无脑积水情况下出现视乳头水肿的情况鲜有报道，其机制也知之甚少。我们报告一例20岁女性患者，眼底镜检查显示视力下降及双侧视乳头水肿。磁共振成像（MRI）显示为巨大前庭神经鞘瘤，无脑积水迹象。术前影像学检查中唯一提示压力升高的影像学证据见于T2加权MRI，显示视神经鞘蛛网膜下腔有轻微扩张。我们推测该患者视乳头水肿是由某种与脑积水无关的机制引起的。对于年轻患者，视乳头水肿可能是脑积水之前的体征，或者她可能同时患有前庭神经鞘瘤伴发的假性脑瘤。无论哪种情况，切除前庭神经鞘瘤都解决了问题。无论机制如何，她的视力都完全恢复了。
