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Chiasmal glioma in spasmus nutans: a cautionary note
Michael C Brodsky1, Gesina F Keating
1Departments of Ophthalmology (MCB) and Neurology (MCB, GFK), Mayo Clinic, Rochester, Minnesota.
Summary
Spasmus nutans in infants can resolve spontaneously, but this does not rule out an underlying chiasmal glioma. Continued monitoring is essential even after symptom resolution.
Area of Science:
- Pediatric Ophthalmology
- Neuro-oncology
- Pediatric Neurology
Background:
- Spasmus nutans is a triad of nystagmus, head nodding, and torticollis, typically presenting in infancy.
- Chiasmal glioma is a tumor affecting the optic chiasm, often presenting with visual pathway abnormalities.
- The spontaneous resolution of spasmus nutans can sometimes mask underlying serious conditions.
Observation:
- An 8-month-old infant presented with spasmus nutans, which subsequently resolved spontaneously.
- Magnetic resonance imaging (MRI) revealed a chiasmal glioma.
- The tumor size remained stable over an 8-month follow-up period after the resolution of spasmus nutans.
Findings:
- Clinical resolution of spasmus nutans does not exclude the presence of an underlying chiasmal glioma.
- Chiasmal glioma can be present asymptomatically or with subtle signs that may be overshadowed by other conditions.
- Stable tumor size despite clinical improvement suggests a slow-growing or indolent nature of the glioma.
Implications:
- Pediatricians and ophthalmologists should maintain a high index of suspicion for chiasmal glioma in infants with spasmus nutans, even if symptoms resolve.
- Neuroimaging is crucial for definitive diagnosis and monitoring of chiasmal glioma.
- Long-term surveillance is recommended for infants diagnosed with chiasmal glioma to monitor tumor progression and potential visual deficits.
