Neuro-Ophthalmic Manifestations of Suprasellar Pilomyxoid Astrocytoma

This case report highlights a case of suprasellar pilomyxoid astrocytoma (PMA) presenting with the diencephalic syndrome (DS) that was initially diagnosed as pilocytic astrocytoma (PA) but had subsequent histopathological re-classification as PMA. A 14-year-old male treated with four subtotal resections for PMA and post-operative radiation therapy presented with bilateral visual loss. The patient was initially diagnosed with PA until the fourth craniotomy was performed and the histopathology was revised from PA to PMA. The patient's ocular examination was remarkable for right cranial nerve III and VI nerve palsy and bilateral optic atrophy. This unique case demonstrated the behavior of a rare and aggressive variant of PA. Awareness of this glioma may help ophthalmologists distinguish PMA from PA. Due to the many histopathological similarities, previously diagnosed cases of PA may be the more aggressive variant, PMA. As PMA progresses, it affects the patient's vision; therefore, an ophthalmological evaluation should be included to monitor disease progression and vision loss.