유방암의 연수막 파종과 동반된 시신경 침윤 1예

A Case of Presumed Optic Nerve Infiltration Associated with the Leptomeningeal Seeding of the Breast Cancer

Purpose: We report a case of presumed optic nerve infiltration associated with the leptomeningeal seeding of the 37- year-old breast cancer patient complaining sudden diplopia. Case summary: A 37-year-old woman receiving chemotherapy because of inoperable breast cancer presented to us with a sudden onset diplopia. The ophthalmologic examination demonstrated a 25 prism diopter esotropia at primary gaze, 30 prism diopter esotropia at the right gaze and abduction limitation in the right eye. The fundus exam showed bilateral papilledema. Visual acuity, anterior segment exam, visual field test and color vision test were normal. Brain magnetic resonance imaging showed no parenchyme infiltration and no enhancement lesion. In the results of cerebral spinal fluid exam, the elevated intracranial pressure (345 mm Hg) and the malignant cells were observed. The diplopia was improved right after lumbar puncture. But 1-month after controlling the intracranial pressure, the aggravating disc edema and color vision abnormalities of the both eyes were founded. Conclusions: Breast cancer is the most common primary site of the ocular metastatic tumors. In the eye, highly vascularized choroid is the most frequently metastasis site of the breast cancer. We experienced presumed optic nerve infiltration, which the papilledema were aggravated while controlling intracranial pressure, in patient diagnosed as the leptomeningeal seeding of breast cancer.