Neuro-Ophthalmology

Case 13

Patient Presentation: A 38-year-old female was referred to an ophthalmologist after her optometrist detected an abnormality in one of her optic discs on fundoscopy.  Her visual acuity on presentation is 20/20 OU with no RAPD. Humphrey’s visual fields were performed below.

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An OCT Enhanced Depth Imaging 5-line raster of both optic nerves was performed and is shown below.

Neuro-Ophthalmology 13-3.png
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Question: What abnormality does the patient likely have?

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The optic nerve photos on fundoscopy are shown above highlighting the optic disc edema and peri-papillary wrinkles (green arrows).

Neuro-Ophthalmology 13-8.png
Neuro-Ophthalmology 13-9.png

Question: The OCT of the RNFL and macular GCIPL are shown above.  Which of the following is seen?

Neuro-Ophthalmology 13-10.png
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Question: The OCT macula 5-line raster is shown above. What abnormality is seen?

Question: Considering that the patient has normal visual function, mild left optic disc edema and irregular contour of the globe, what is the most likely diagnosis?

Learning Objectives:

1. To recognize the manifestations of cavernous hemangioma on OCT

2. Identify neuroimaging features that suggest cavernous hemangioma