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Joseph Junewick, MD FACR
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Optic Nerve Pilocytic Astrocytoma

Case Detail

Anatomy: Neck-Face
Joseph Junewick, MD FACR
Diagnostic Category: Neoplasia Malignant
Created: over 9 years ago
Updated: over 9 years ago
Tags: PEDS
Modality/Study Types: MR
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Teenager with proptosis and history of malignant germ cell tumor of the abdomen.

Case Images


Optic Nerve Pilocytic Astrocytoma


MR – Axial fat-suppressed T2 and post-gadolinium T1 images demonstrate hyperintense fusiform mass of the intraconal left optic nerve.


Pilocytic astrocytoma of the optic pathway frequently produces visual loss or visual-field deficit. Associated proptosis leads to optic nerve atrophy secondary to axonal damage and ischemia. Papilledema is common for lesions arising from the optic nerve but unusual for those originating from the optic chiasm. Some patients may show spasmus nutans, a nystagmus characterized by high frequency and low amplitude and associated with head nodding movements. Precocious puberty is commonly seen in patients with neurofibromatosis and optic pathway glioma. Small lesions may be asymptomatic. Pilocytic astrocytoma occurs most commonly in the first 2 decades of life with no gender predilection. Most of the lesions occur in or near the midline, usually arising from the cerebellum, the optic nerve and chiasm, or the region of the hypothalamus-thalamus. Pilocytic astrocytomas account for two-thirds of all neoplasms of the optic nerve.


Koeller KK, Rushing EJ. Pilocytic Astrocytoma: Radiologic-Pathologic Correlation. RadioGraphics (2004); 24:1693-1708.

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