Neuro-ophthalmic and clinical characteristics of brain tumours in a tertiary hospital in Ghana
Background: Anecdotally, increasing number of patients are seen at Korle Bu Teaching Hospital (KBTH) with brain tumour. Neuro-ophthalmic symptoms and signs may help in timely diagnosis and intervention.
Objective: To evaluate the neuro-ophthalmic and clinical characteristics of brain tumour in patients presenting at a tertiary hospital in Ghana.
Study design: A prospective case series involving 36 consecutive patients newly diagnosed with brain tumour from November 2010 to October 2011, at the Ophthalmology, Neurosurgery and Endocrine units of KBTH, Ghana. All patients had clinical diagnosis of brain tumour with confirmation by computerized tomography (CT) or magnetic resonance imaging (MRI). Thirteen patients had histological confirmation of diagnosis. Outcome measures: Presenting Visual acuity, Colour vision, Visual fields and Cranial nerve deficits.
Results: Data of 36 patients were analyzed. Ages ranged from 3 to 69years, mean (SD) 42.56(±16.6 years). Twenty-six (72%) were females. Tumours included pituitary adenoma (20,55.5%), meningioma( 10,27.8%), choroid plexus tumour(1,2.8%), medulloblastoma(1,2.8%),craniopharyngioma(1,2.8%), haemangioblastoma( 1,2.8%), thalamic tumour(1,2.8%) and haemangioma(1,2.8%). Histologically confirmed tumours included pituitary adenoma (9, 69.2%), meningioma (3, 23.1%), craniopharyngioma (1, 7.7%). One patient had both a pituitary adenoma and meningioma. Blurred vision (30, 83.3%), headache (28, 77.8%) and photophobia (13, 36.1%) were predominant symptoms. Commonest neuro-ophthalmic signs were impaired colour vision (62 eyes, 88.6%), optic atrophy (26, 74.3%), unilateral or bitemporal hemianopia (15, 41.5%) and relative afferent pupillary defect (12, 34.3%). Seven (19.4%) patients were visually impaired and nine (25%) blind. Thirty-three of 72(45.8%) eyes had monocular blindness.
Conclusions: Common neuro-ophthalmic characteristics were blurred vision, headache, impaired colour vision, optic atrophy, and relative afferent pupillary defect (RAPD). Significant numbers of patients were blind or visually impaired at presentation.
Keywords: Brain tumour, neuro-ophthalmic characteristics, visual impairment, blindness, optic atrophy