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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Case of the Month

Section Editor: Nicholas Stence, MD
Children's Hospital Colorado, Aurora, CO

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November 2014
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Next Case of the Month coming December 2 . . .

Malignant Optic Pathway Glioma

  • Malignant optic pathway glioma in adulthood is extremely rare, with less than 50 cases reported.
  • In contrast with the far more common optic glioma, in children with neurofibromatosis type 2 (NF-2), in adults without NF:
    • The optic chiasm is frequently involved.
    • It usually spreads contiguously beyond visual pathways (hypothalamus in 50%, temporal lobe in 22.5%, and basal ganglia in 15%).
    • They are high-grade gliomas, classified pathologically as anaplastic astrocytoma or glioblastoma.
  • Clinical Presentation: Subacute visual loss—monocular or hemianopia if optic nerve or chiasm is involved (respectively); typical signs of intracranial mass are usually absent.
  • Key Diagnostic Features:
    • Expansive and infiltrative mass involving any component of the optic pathway (optic nerve, chiasm or optic tract), which can extend to the contiguous structures.
    • High signal on T2WI and low signal on T1WI, usually contrast-enhancing, with variable restricted diffusion and increased relative cerebral blood volume on perfusion
    • Associated with mass effect and variable amounts of vasogenic edema
  • DDx:
    • Lymphoma
    • Demyelinating disease
    • Infectious and granulomatous disease
    • Leukemia and metastasis
  • Rx:
    • Surgery, radiation, and/or chemotherapy, with poor results
    • Malignant visual pathway gliomas grow fast and are rapidly fatal, with mean survival time being less than 1 year.

Suggested Reading

  1. Brar R, Prasad A, Brar M. Glioblastoma of the optic pathways: an atypical case. J Radiol Case Rep 2009;3:22–28, 10.3941/jrcr.v3i9.277
  2. Kornreich L, Blaser S, Schwarz M, et al. Optic pathway glioma: correlation of imaging findings with the presence of neurofibromatosis. AJNR Am J Neuroradiol 2001;22:1963–69
  3. Millar WS, Tartaglino LM, Sergott RC, et al. MR of malignant optic glioma of adulthood. AJNR Am J Neuroradiol 1995;16:1673–76

Current Issue

American Journal of Neuroradiology: 46 (6)
American Journal of Neuroradiology
Vol. 46, Issue 6
1 Jun 2025
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Print ISSN: 0195-6108 Online ISSN: 1936-959X

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