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Table 3 Patients with worsened visual acuity

From: Retrospective analysis of fractionated intensity-modulated radiotherapy (IMRT) in the interdisciplinary management of primary optic nerve sheath meningiomas

Clinical history Discussion / presumable diagnosis
1 Male 48 years: Visual acuity 0.2 before and at the end of radiotherapy, perception of hand movements at next visit one year later. Optic atrophy. D2 optic nerve 53.41 Gy. RION (Radiation-induced optic neuropathy)
2 Male 82 years: Two years before radiotherapy the patient suffered from a stroke with persisting facial nerve palsy on the side of the meningioma. Corneal ulcers were present before and after therapy. Visual acuity was perception of hand movements before radiotherapy and no light perception after therapy. Multifactorial process including facial nerve palsy and corneal ulcers
3 Female 50 years. Visual acuity 0.63 6 weeks before radiotherapy. 2 months after radiotherapy only perception of handmovements. Unusual imaging finding: strong contrast enhancement even 5 years after therapy, relatively mild SSR analogon-uptake in PET. Atypical PET-signal for ONSM before start of radiotherapy, possibility of misdiagnosis
4 Female 56 years. Visual acuity 0.04 1 week before radiotherapy. Relatively mild SSR analogon-uptake in PET. Visual acuity 0.5 3 months after therapy. Subacute visual loss accompanied by pain with eye movements 20 months after therapy. Visual loss to perception of hand movements, no improvement. At the time of visual loss a long and marked contrast enhancement was seen in the optic nerve which was much less pronounced 3 months earlier. Atypical PET-signal for ONSM before start of radiotherapy, possibility of misdiagnosis
5 Female 70 years. Visual acuity 0.63 2 weeks before therapy. Six weeks after radiotherapy visual acuity was 0.16 and a macular oedema was seen in OCT. Visual acuity improved again to 0.4. Visual field improved. D2 eye 51.72 Gy Radiation-induced retinopathy