Intracranial Pure Germinoma With Optic Nerve Infiltration

Devon A. Cohen, M. Tariq Bhatti, Caterina Giannini, Laurence Eckel, James A. Garrity, John J. Chen

Research output: Contribution to journalArticle

Abstract

A 19-year-old man presented with a 3-year history of episodic headaches, right hemiparesis, and progressive vision loss in both eyes. Initially, extensive laboratory testing was unrevealing. MRI later demonstrated progressive enlargement and enhancement of the left optic nerve poorly correlated with the timing of his clinical manifestations. There was no clinical or radiological response to treatment with corticosteroids, mycophenolate mofetil, or rituximab administered empirically for possible inflammatory processes. Later in the disease course, he developed diabetes insipidus (DI), worsening vision to light perception bilaterally, severe cognitive decline, and spastic quadriparesis. Cerebrospinal fluid (CSF) beta human chorionic gonadotropin (β-hCG) was elevated. Eventually, a left optic nerve biopsy was performed, which was consistent with an intracranial pure germinoma with infiltration of the optic nerve and disseminated leptomeningeal disease. Although rare, intracranial germ cell tumors can primarily involve the anterior visual pathways and should be considered in the setting of DI and elevated CSF β-hCG.

Original languageEnglish (US)
Pages (from-to)112-116
Number of pages5
JournalJournal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society
Volume40
Issue number1
DOIs
StatePublished - Mar 1 2020

ASJC Scopus subject areas

  • Ophthalmology
  • Clinical Neurology

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