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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 24:1167-1170, June-July 2003
© 2003 American Society of Neuroradiology

Case Report
HEAD AND NECK

Intracanalicular Optic Nerve Meningioma: A Serious Diagnostic Pitfall

Alan Jackson^a, Tufail Patankar^a and Roger D. Laitt^b

^a Department of Imaging Science, Department of Medicine, University of Manchester, Manchester, UK
^b Manchester Royal Infirmary, Manchester, UK

Address correspondence to Professor Alan Jackson, Imaging Science, Department of Medicine, University of Manchester, Oxford Road, Manchester, M13 9PT, UK

Summary: We describe six cases of cannalicular optic nerve meningioma in which the diagnosis was missed for more than 1 year after the onset of symptoms. Clinical features led to a misdiagnosis of optic neuritis in all cases. Although atypical clinical progression led to further imaging studies, they did not provide the diagnosis because of inappropriate imaging protocols. Diagnosis was eventually made on the basis of high-spatial-resolution contrast-enhanced MR findings. Radiologists should have a high suspicion for the diagnosis of optic canal meningioma in patients with unexplained visual loss, particularly when visual loss is progressive. Investigation in these cases should include high-spatial-resolution MR imaging of the orbit before and after contrast medium administration, and fat suppression should be used in combination with contrast enhancement whenever possible.