Visual loss as the initial symptom in Hodgkin disease

N. R. Miller and W. J. Iliff

Involvement of the visual system in Hodgkin Disease generally occurs late in the course of the illness. A 43-year-old man was seen at the Johns Hopkins Hospital complaining of monocular visual loss. Clinical observations and neuroradiologic examinations suggested a chiasmal mass lesion, and the patient underwent a frontal craniotomy with biopsy of the chiasm. The biopsy specimen was diagnosed as a spongioblastoma of the optic chiasm, and the patient underwent a course of radiotherapy. Shortly after craniotomy, the patient developed evidence of a systemic illness and died eight months after onset of visual symptoms. Autopsy revealed extensive systemic involvement by Hodgkin sarcoma. Microscopical examination of the optic chiasm revealed no evidence of optic glioma but revealed diffuse infiltration by Hodgkin sarcoma. Reexamination of the original biopsy specimen confirmed that initial visual symptomatologic findings were secondary to intracranial Hodgkin disease.