TITLE OPTIC NERVE SHEATH MENINGIOMA INTRODUCTION - Optic nerve sheath meningioma (ONSM) is a term applied to primary and

d secondary meningioma of the optic nerve. ONSM occurs more commonly in middle aged women. Primary ONSM represents a neoplasia of meningo-endothelial cap cells of arachnoid villi and can develop anywhere along the course of the optic nerve. Incidence is 4 per 1lakh population PURPOSE -To report a rare case of optic nerve sheath meningioma MATERIAL AND METHODS - 55yr old female patient , Snellens visual acuity chart , slit lamp , torch , scales , 90D lens , direct and indirect ophthalmoscope, CT Scan Orbits and brain. CASE HISTORY 55yr old female patient presented to ophthalmology OPD with complaints of protrusion of right eye and gradual painless loss of vision in right eye since 5 years and loss of movements in the same eye since 2yrs. On examination Left eye- anterior segment and fundus were normal and visual acuity was 6/6 Right eye - was in 15 degrees exotropia and was not taking fixation on cover test Visual acuity was perception of light and projection of rays are present in all quadrants. Axial proptosis of about 26mm was present All extra-ocular movements were absent ANTERIOR SEGMENT Lids edema of upper and lowerlid Conjunctiva chemosis and nasal pterygium Cornea ,anterior chamber , iris were normal Pupil RAPD present Lens transperant

FUNDUS media was clear Optic disc edematous disc with blurred margins tortous veins and attenuated arteries noted Macula dull FR

General investigations- CBP, RBS , CHEST X-RAY , T3 ,T4 ,TSH were normal SPECIFIC INVESTIGATIONS HIGH RESOLUTION CONTRAST ENHANCED CT ORBITS AND BRAIN showed homogenous mass lesion measuring 45 X 32mm arising from right optic nerve sheath , infiltrating all recti muscles & oblique muscles. mass is seen extending intracranially along the optic nerve sheath through optic foramen. mass seen in right frontal horn, suprasellar & parasellar regions and has mass effect on frontal lobe. Post contrast scan showed intense, almost homogenous pattern of enhancement. Findings are suggestive of right optic nerve sheath meningioma with intracranial spread

DISCUSSION optic nerve sheath meningioma usually presents with clinical profile of slowly progressive visual loss , colour vision disturbance, visual field defect, proptosis, optic disc oedema or atrophy and motility disturbance. The diagnosis of OSNM relies heavily on CT or MRI findings. High resolution CT using 1.5mm sections with oblique coronal and sagittal reconstruction usually shows a enhancing mass lesions around the optic nerve with tram-track calcification. High resolution contrast enhanced CT is preferred over MRI in the determination of intracranial extension of ONSM CONCLUSION - All cases of unilateral proptosis associated with loss of vision must be thoroughly evaluated with fundus examination and radiological investigation like B-scan ,CT scan , MRI scan to rule out rare causes like optic nerve sheath meningioma. Clinical profile of slowly progressive visual loss associated with proptosis, strabismus, RAPD , optic disc edema and limited movements usually suggests ONSM Diagnosis can be confirmed radiologically using CT or MRI