case 397 Foster Kennedy syndrome

Video from Tageldin Aly

[dr.tageldinaly]

Question

An 11-year-old boy was experiencing progressively decreased vision in the left eye for the last 8 months. 3D Optical coherence tomography (OCT) shows left optic atrophy and right papilledema. OD = RIGHT and OS= LEFT

1. What do you see in his short video? (The examination of ocular movement just for left side)

2. What is(are) the possible clinical diagnoses in a patient with papilledema in one eye and disc pallor in the other eye?


3. What is the next step?

Answer

Foster Kennedy syndrome Foster Kennedy described patients with ipsilateral disc pallor, secondary to optic nerve compression, and contralateral papilledema. Pre-existing optic atrophy precludes the development of papilledema, because there are no fibers to swell. Classically, the culprit lesion in Foster Kennedy syndrome is a subfrontal mass, typically a meningioma, which compresses the ipsilateral optic nerve, causing disc atrophy.

If the lesion is large enough to cause elevated intracranial pressure, papilledema results in the contralateral eye only, owing to the ipsilateral nerve atrophy. Bilateral optic nerve compression is another possible mechanism.

Non-tumor causes, resulting in pseudo-Foster Kennedy syndrome, are actually more common. One example is consecutive anterior ischemic optic neuropathy, characterized by new ischemic disc swelling in one eye accompanied by longstanding disc atrophy resulting from a previous ischemic event in the other eye. Unlike the true Foster Kennedy syndrome, the eye with the disc swelling will usually have impaired visual acuity.
Dr zuhair
ومن أحياها فكأنما أحيا الناس جميعا
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