Journal of Child Neurology
J Child Neurol 2010; 25; 321
Received August 11, 2009. Received revised August 26, 2009. Accepted
for publication August 26, 2009.
Francis J. DiMario, Jr, Mirna Hajjar and Thomas Ciesielski
We report the course of a 16-year-old girl who presented with near complete visual loss associated with chiasmal neuritis and a biopsy proven tumefactive demyelinating lesion on magnetic resonance imaging (MRI) in association with a recent immunization against human papilloma virus.
Keywords: demyelination;tumefactive; blindness; chiasm;HPV
Visual loss is a symptom that can occur from lesions anywhere along the visual pathways. Binocular visual loss can be further localized depending on
the size and location of the scotoma identified on examination. Lesions affecting the chiasm, in particular, may produce bitemporal visual field loss and the additional involvement of the optic nerves and/or retrochiasmatic
visual pathways will induce more complete degrees of blindness. There are a multitude of etiologies that produce this latter pattern of visual loss; however, the pace of progression, the anatomic localization of the process, and the
precipitating circumstances will aid in pathophysiologic classification as compressive or noncompressive. Noncompressive etiologies involving the chiasm include processes within the spectrum from acute to a more chronic
temporal course. This slower time course is characteristic of infiltrative lesions, granulomatous diseases, axonal dieback phenomenon secondary to multiple sclerosis,1 and Leber hereditary optic neuropathy. Acute noncompressive lesions of the optic chiasm have been described in infectious
settings with Lyme disease,2 Epstein-Barr virus,3,4 varicella zoster virus5 and mumps,6 systemic lupus erythematosus, 7,8 and demyelinating processes (eg, neuromyelitis optica and multiple sclerosis). Tumefactive demyelinating lesions are those defined as large (>2 cm) lesions with a surrounding zone of edema with or without accompanying mass effect. There have been a few case
reports and case series in the literature where tumefactive lesions have been described in the context of both multiple sclerosis and acute demyelinating encephalomyelitis.
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