Unilateral Compressive Optic Neuropathy As the Presenting Manifestation of Clival Chordoma: A Case Report

The optic nerve(s) may be compressed by a number of intracranial and intraorbital masses. Compression may be isolated to the optic nerve or may involve other intracranial or intraorbital structures with variable presentation. A 26-year-old man presented with complaints of progressive painless visual loss in the right eye for eight months. Examination revealed isolated unilateral optic atrophy consistent with a diagnosis of compressive optic neuropathy. Magnetic resonance imaging of the brain showed compression of the anterior visual pathways due to a lesion radiologically compatible with clival chordoma. He underwent subtotal neurosurgical resection and pathology was consistent with chordoma. Although rare, isolated unilateral visual loss may be the only presenting manifestation of clival chordoma.