See-saw nystagmus caused by an optic nerve glioma: a case report

Aisling McGlacken-Byrne


Purpose and Aim: There has been an increasing trend towards Gliomas are the most common paediatric tumours of the central nervous system, exhibiting a broad range of clinical behaviours depending on origin, size and pathological subgroup. Knowledge of current and evolving advances in molecular characterization of this tumour is needed to ensure effective management. A 2-year-old boy presented with nystagmus since 10 months of age. Parents described initially left eye moving horizontally then right eye moving horizontally, then both with a vertical component. Poor vision was reported, with running into objects and difficulty recognizing people far away. He was otherwise well, normal term vaginal delivery and reaching developmental milestones. On examination the boy had high frequency, small amplitude see-saw nystagmus. It had no null point and no change with convergence or fixation. He had no anomalous head position and a normal red reflex with clear corneas. Dilated exam under general anaesthetic revealed left subtle nerve pallor and atrophy. Magnetic resonance imaging revealed a large optic nerve glioma originating from the optic nerve chiasm, spreading anteriorly and posteriorly. Our case documents see-saw nystagmus in a patient with likely bi-temporal hemianopia due to a large tumour but without mesencephalic compression or CSF dissemination. Because preschool children rarely complain about poor vision, by the time symptoms manifests, the disorders of vision have already progressed. Early diagnosis is paramount in diagnosing these often silently enlarging optic pathway gliomas.

Relevant Publications in Clinical & Experimental Ophthalmology