PMC7680680_01
(A) Fundus photo on presentation: elevated left optic disc with indistinct margins. (B) Fundus photo 1 month after posterior fossa decompression with duraplasty. Regression of papilledema. (C) Pre-operative MRI: Etaerniation of the cerebellar tonsils below the foramen magnum. (D) MRI after posterior fossa decompression with duraplasty and cerebellar tonsillectomy.
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Fundus examination of the left eye revealed an elevated optic disc with superior indistinct margins (Figure 1A). After a neurosurgical evaluation including a brain MRI (Figure 1C) which confirmed the CT findings the decision for an immediate surgical treatment was made. Afterwards, a cerebellar tonsillectomy was performed preserving both posterior inferior cerebellar artery (PICA) (Figure 1D). Visual acuity was 20/20 sc in both eyes and the optic disc at the left eye showed a minimal residual marginal haziness (Figure 1B).
(A and B) Early and late venous FA phases showing staining of the lower margin of the left optic disc. (C) Left visual field examination showing severe, almost amaurotic, defects.
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In the left eye however FA showed staining of the lower margin of the optic disc (Figure 2A and B). Visual field examination confirmed significant amaurosis on the left eye (Figure 2C).