Paraneoplastic optic neuropathy (PON) is a rare disorder that is associated with malignant tumors, such as small-cell lung carcinoma and lung adenocarcinoma and malignant lymphoma.1, 2 PON caused by non-malignant tumors has not yet been reported in the literature.
A 39-year-old woman reported experiencing headache and was taking demulcents for 9 months. Six months prior, she had experienced fever, headache, and dizziness, followed by sudden vision loss in the left eye. She visited our hospital in March 2012. Her best-corrected visual acuity (BCVA) was 20/20 OD and 20/250 OS, with an afferent pupillary defect and paracentral scotoma OS. The right eye had normal visual field. Critical flicker frequency OS decreased to 15 Hz. Color vision, the slit-lamp and dilated funduscopic examinations, and full-field and multifocal electroretinogram findings were all unremarkable OU.
Magnetic resonance imaging (MRI) disclosed a gadolinium-enhancing lesion in the left cerebellar hemisphere (Figure 1a), but did not show any optic nerve abnormalities.
The patient’s plasma, which was collected at the first visit, was cross-reacted with rat, monkey, and human optic nerve sections (Figure 1b).
Two months after presentation, the cerebellar tumor was surgically removed. The histopathological diagnosis of the tumor was chordoid meningioma. The patient felt visual improvement at the next day after the resection, and the BCVA OS improved to 20/33 after 1 week and to 20/20 after 1 month, with the resolution of other symptoms, which was maintained at the last visit for 1 year.
PON occurs in association with immunologic responses against neuronal antigens that are expressed by the underlying cancer.3, 4 In our case, immunoreactivities of the patient’s plasma to the optic nerve sections strongly indicated the existence of a certain autoantibody that most likely targeted the optic nerve fibers.
Chordoid meningioma, which is assigned to WHO grade II (atypical meningioma), is a rare meningioma that is sometimes associated with Castleman syndrome and characterized by fever of unknown origin, hematological abnormalities (eg, hypochromic or microcytic anemia), and dysgammaglobulinemia, with bone marrow plasmacytosis.5 The present case accompanied these symptoms.
Unilateral involvement of optic nerve in this case could not be fully explained, but some previous reports demonstrated such pattern with paraneoplastic syndrome.6, 7 We need to be aware of unilateral paraneoplastic syndrome.
Chan JW . Paraneoplastic retinopathies and optic neuropathies. Surv Ophthalmol 2003; 48: 12–38.
Ko MW, Dalmau J, Galetta SL . Neuro-ophthalmologic manifestations of paraneoplastic syndromes. J Neuroophthalmol 2008; 28: 58–68.
Murakami Y, Yoshida S, Yoshikawa H, Yamaji Y, Ikeda Y, Ueno A et al. CRMP-5-IgG in patient with paraneoplastic optic neuritis with lung adenocarcinoma. Eye (Lond) 2007; 21: 860–862.
Peterson K., Rosenblum M. K., Kotanides H., Posner J. B . Paraneoplastic cerebellar degeneration. I. A clinical analysis of 55 anti-Yo antibody-positive patients. Neurology 1992; 42: 1931–1937.
Ozen O., Sar A., Atalay B., Altinors N., Demirhan B . Chordoid meningioma: rare variant of meningioma. Neuropathology 2004; 24: 243–247.
Subhadra C., Dudek A. Z., Rath P. P., Lee M. S . Improvement in visual fields in a patient with melanoma-associated retinopathy treated with intravenous immunoglobulin. J Neuroophthalmol 2008; 28: 23–26.
Janaky M., Palffy A., Kolozsvari L., Benedek G . Unilateral manifestation of melanoma-associated retinopathy. Arch Ophthalmol 2002; 120: 866–867.
This work was supported by JSPS KAKENHI grant number 23791983 (AK) and 20592043 (MN, AN) from the Japanese Government, the Suda Memorial Foundation (AK), the Mishima Memorial Foundation (AK), and the Santen Pharmaceutical Founder Commemoration Ophthalmic Research Fund (AK).
The authors declare no conflict of interest.
About this article
Cite this article
Nakano, S., Kanamori, A., Nakamura, M. et al. Paraneoplastic optic neuropathy associated with cerebellar choroid meningioma. Eye 27, 1220–1221 (2013). https://doi.org/10.1038/eye.2013.150
Brain and Behavior (2016)
Journal of Neuro-Ophthalmology (2015)