- Primary CNS lymphoma (PCNSL) is a rare form of extranodal, high-grade, non-Hodgkin lymphoma (NHL), accounting for approximately 3% of newly diagnosed brain tumors and 2 to 3% of all NHL.1 PCNSL can also arise from posttransplant lymphoproliferative disorder (PTLD), a disorder in patients with secondary immunodeficiency after a solid organ or hematopoietic stem cell transplant.2 PCNSL is characterized by rapid growth usually confined to the CNS and can originate in the brain, leptomeninges, spinal cord, or eyes.
- Bilateral optic disc edema can be a result of several etiologies and deserves a thorough work-up. Neuroimaging and laboratory studies should be performed to rule out neoplastic, vascular, infectious, ischemic, or inflammatory etiologies, and a lumbar puncture (LP) should be performed to measure intracranial pressure (ICP) if necessary after performing the appropriate imaging studies. Patients with papilledema should be evaluated for alternative causes of increased ICP. We present the case of a patient who presented with bilateral optic disc edema and was found to have increased ICP.
- Systemic lupus erythematosus (SLE) is an autoimmune disease that can affect many different organ systems and present in a variety of ways. The central nervous system (CNS) is frequently affected, resulting in a wide range of manifestations. Patients may present to an ophthalmologist with ocular symptoms before a diagnosis is established; thus, early recognition is important to avoid delays in diagnosis and treatment. We report the first case of a patient with lupus who developed nine syndrome due to pontine ischemic stroke precipitated by CNS vasculitis.
- Cerebellopontine angle (CPA) extra-axial lesions (e.g., classically the vestibular schwannoma) may cause a characteristic neuro-ophthalmologic sign known as the Bruns nystagmus, a gaze-evoked horizontal nystagmus when looking away from the lesion and a gaze-paretic type nystagmus when looking toward the lesion. In contrast, intra-axial exophytic CPA astrocytomas are rare and, to our knowledge, have not been reported in the English-language ophthalmic literature previously as a cause of Bruns nystagmus.
- Internuclear ophthalmoplegia (INO) is caused by a lesion in the medial longitudinal fasciculus (MLF). It is characterized clinically by an ipsilateral adduction deficit (e.g., adduction deficit or lag) and a dissociated, horizontal, abducting nystagmus of the contralateral eye on attempted horizontal gaze. A similar clinical presentation not attributable to a lesion in the MLF, called a pseudo-INO, is usually caused by myasthenia gravis. We present a rare case of an apparent INO resulting from rectal adenocarcinoma metastasis to the orbit.