Suprasellar Meningioma Mimicking Optic Neuritis Presentation – Challenges in Diagnosis

Abstract

The clinical presentation of suprasellar meningioma may resemble that of optic neuritis causing diagnostic dilemma. A 40-year-old female presented with progressive blurring of vision in the left eye associated with poor colour perception for 2 weeks duration. The left eye visual acuity was hand movement with positive relative afferent pupillary defect. Examination revealed impaired optic nerve function test and a significant reduction in the colour vision test. Fundoscopy showed a normal optic disc in both eyes. She was suspected to have retrobulbar optic neuritis based on the clinical presentation. She received Intravenous methylprednisolone 1 gram daily, however her visual acuity remained the same. Magnetic resonance imaging (MRI) showed features of suprasellar meningioma. She underwent tumour debulking and her final visual acuity improved to 6/6 after the surgery. The similarity in clinical presentations of optic neuritis and suprasellar meningioma created a diagnostic challenge, wherein MRI plays a crucial role in differentiation.