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Título

Sphenoclival Intraosseous Lesion mimicking Acute Optic Neuritis: a case report

RESUMO

Case Summary: This 17 year old patient was referred to the Emergency Room for Neurological evaluation due to acute painful right eye vision loss, involuntary ipsilateral eyelid movements and pulsatile occipital pain. Pain was also triggered by eye movement. It was obtained pain relief with good response to simple analgesics, despite her past medical history of Migraine. Additionally, physical examination revealed decreased sensitivity at right V1 trigeminal branch and ipsilateral reduced visual acuity. Brain and Orbits MRI showed T1 and T2 hyperintensity in the medium clivus, with signs of bone destruction and without gadolinium enhancement or DWI restriction. A contrast Brain CT was also performed which showed no signs of vascular stenosis or venous thrombosis, even though some bone destruction could be noticed. Given the pain improvement, our patient was referred for follow-up at the clinic and possibly elective byopsy.

Discussion: Depending on the tumor growth direction and speed, infiltrative sphenoclival lesions can mimick acute optic neuritis, including intraosseous lipoma as a distintictive diagnosis to be considered. Although byopsy was not yet performed, MRI seems to be very useful for evaluating this condition.

Conclusion: Intraosseous lipoma is a hamartoma rarely manifested in the sphenoclival topography and often asymptomatic. MRI can be very suggestive, however byopsy is essential to properly diagnose and manage this condition.

Palavras Chave

Sphenoclival Intraosseous Lipoma; Optic Neuritis; Clivus lesion

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