Acute, severe, symmetric visual loss with cecocentral scotomas due to olfactory groove meningioma

Cecocentral scotomas are a hallmark of toxic, metabolic, and hereditary optic neuropathies, but are rarely associated with compressive processes. Acute visual loss due to a compressive optic neuropathy by a benign tumor is unusual unless intratumoral hemorrhage or infarction occurs. A case of acute, severe, remitting, symmetrical visual loss with cecocentral scotomas, initially thought to be of toxic etiology, proved to be due to a typical suprasellar meningioma originating in the olfactory groove. A history of olfactory disturbance with visual loss should prompt neuroradiologic investigation despite atypical neuro-ophthalmic features.