Opticochiasmatic apoplexy in a five-year-old

A 5-year-old female presented to the emergency department with a 24-hour history of nausea, vomiting and mental status changes. Imaging demonstrated hemorrhage from a suprasellar mass consistent with an optic nerve glioma. The patient was taken to surgery for an open biopsy and hematoma evacuation. Pathology revealed a grade 3 fibrillary astrocytoma. She was subsequently treated with carboplatin and vincristine and is now 2 years out without evidence of recurrence. Apoplexy is a rare presentation for an optic pathway glioma. To the authors' knowledge, this is the first reported case in the pediatric population. Clinical presentation appears similar to the symptoms observed in pituitary apoplexy. Timely surgery should be directed at obtaining diagnostic tissue, prevention of long-term nervous system damage and evacuation of the hematoma where feasible.