Optic chiasm glioma associated with inappropriate secretion of antidiuretic hormone, cerebral ischemia, nonobstructive hydrocephalus and chronic ascites following ventriculoperitoneal shunting

Abstract

An optic chiasm glioma may cause loss of vision, endocrine disturbances, hydrocephalus and cerebral ischemia due to its proximity to the pituitary, hypothalamus, III ventricle and internal carotids. A 3-month-old infant with optic chiasm glioma developed hypopituitarism and inappropriate secretion of antidiuretic hormone with plasma hypo-osmolality. The cerebrospinal fluid (CSF) protein concentration was markedly elevated. The impairment of fluid absorption via arachnoid villi and peritoneum by the high protein content, and reversed osmotic gradient between protein-rich CSF and hypo-osmolar plasma may have contributed to both nonobstructive hydrocephalus and recurrent ascites following ventriculoperitoneal shunting. Cerebral ischemia from carotid compression may have led to cerebral atrophy.

Beta-2-transferrin to detect cerebrospinal fluid pleural effusion: a case report

“…According to this supposition, an elevated CSF protein content may lead to reversed osmosis at the level of the blood-brain barrier with the resultant accumulation of excessive CSF fluid within the peritoneal cavity [13]. However, numerous cases of high CSF protein without resultant ascites have been reported [9].…”

Hypothalamic Glioma Presenting with Seizures

“…The overall 5-year survival rate of patients with chiasmatic and hypothalamic gliomas is reported to vary between 40 and 88% [8, 17]. Patients with an optic pathway tumor and neurofibromatosis type I have a better prognosis than those who do not have neurofibromatosis.…”

“…Tang et al [8] reported a 3-month-old female infant, who developed staring spells, twitching of the right eyelids, and extensive movements of the right arms, the CT scan revealed a lesion involving both optic nerves, optic chiasm, left optic tract and geniculate body and the histopathological diagnosis was astrocytoma. In a series of 19 cases with chiasmal/hypothalamic gliomas reported by Petronio et al [9], visual impairment, obstructive hydrocephalus and endocrinopathies were common presenting symptoms [9].…”

“…Most of the chiasmal and hypothalamic gliomas occur in infants and children and are usually low-grade astrocytomas/pilocytic astrocytomas [9]. With the advent of MRI, lesions involving the retrochiasmal optic pathways and hypothalamus can be distinguished readily from the more indolent anterior optic nerve glioma [1,2,3,8,9,10,11,12]. These gliomas are less amenable to surgical resection, with frequent residual tumors left behind to avoid postoperative neurological deterioration/visual deterioration.…”

Opticochiasmatic Apoplexy in a Five-Year-Old

“…Iraci et al [23] reported a series of 5 patients with precocious or pseudoprecocious puberty associated with optic nerve gliomas. Patients with suprasellar tumors have also presented with symptoms of diabetes insipidus [24], syndrome of inappropriate antidiuretic hormone hypersecretion [25], gigantism [26,27], growth hormone deficiency [28], hypothyroidism, adrenal insufficiency, and gonadotropin insufficiency [29]. Ahn et al [29] presented a series of 33 patients who underwent surgery for optic pathway gliomas; 19 had preoperative endocrine abnormalities.…”