Sequential NAION Presenting

as Pseudo Foster Kennedy

Syndrome
Anuja Patil, Aastha Takkar, Manoj Goyal,
Ramandeep Singh, Vivek Lal
Introduction
Unilate ra l optic dis c e de ma Contralate ra l optic a trophy
P FK
Abs e nce of a ny compre s siv e optic ne rve le sion

Clasically Similar to PFK

Is che mic optic ne uropa thy Cong e nital ON hypopla s ia

Bilate ra l s e que ntial optic ne uritis P a chy me ningitis

Chronic unilate ra l optic a trophy IIH

Introduction
NAION

Mea n a g e 57-65 ye a rs

• S udde n painle s s vision los s

P re s e nts with
• Vis ua l field de fe cts

• Be ri e t a l  25% ove r 3 ye a rs
Involve me nt of fe llow e y e • Be ck e t a l  17% ove r 5 ye a rs
• IONDT  14.7%
 Methods

Inclus ion Exclus ion

1. June 2014 – S e pte mbe r 2015

2. ≥ 14 ye a rs
3. Bilate ra l s e que ntial AION 1. Cong e nital optic dis c a noma lie s
4. Dis c e de ma on one side & optic
a trophy in contralate ra l e y e
Methods

Diagnosis AION

1. S udde n/s e que ntial los s of vision 1 or 2 e y e s

2. Fundus e xa mina tion s ug g e s tive of dis c e de ma /pa llor
3. Vis ua l fields with s pe cific field de fe cts
4. FFA – minima l or no filling de fe ct / de la y filling in the optic dis c
a nd/or pe ripa pillary choroid / choroida l wa te rs he d zone
5. Exclusion of othe r ca us e s of vision los s
Methods

Assesment

Vis ua l a cuity MRI bra in

Automa te d pe rime try Ang iog ra phy

Fundus photog ra phy Ris k fa ctors & va s culitic work up

Results

Mean age 53.7±11.9 ye a rs

Mean duration between episodes 12. 7 months (rang e 2-30)

Visual acuity range 6/9 - CFFC

Results
Discussion
FK syndrome
Unilate ra l dis c a trophy &
contralate ra l dis c e de ma
Robe rt Fos te r Ke nne dy, 1911
Typica lly re s ults from : fronta l
lobe tumours / optic ne rve
me ningioma s
PFK Syndrome
S a me pre s e nta tion, in the a bs e nce
of ma s s / compre s siv e le sions
Fre que nt ca us e s : Optic a trophy from
inflamma tory, tra uma tic, or inhe rite d
AION with s e que ntial bilate ra l
involve me nt : similar
 NAION

Mos t common ca us e of AION in a g e ≥ 50 ye a rs

Ris k fa ctors • Dis c a t ris k • S moking

• Hype rte ns ion • Migra ine
• DM • Drug s
• Hype rlipide mia • Various
• Obs tructive s le e p coa g ulopa thies
a pne a

Ris k in fe llow e y e (IONDT) • Young e r a g e a t ons e t

• P oor ba s e line VA
• P re s e nce of DM
Conclusion
P FK

Dia g nos is of e xclus ion

Tumor causes
Bilateral sequential NAION
 Re a dily e xclude d by
 one of the ca us e
a ppropriate ima ging
THANK YOU
 Unilate ra l optic dis c e de ma Contralate ra l optic a trophy

Foster Kennedy Pseudo Foster Kennedy

Ca us e s : intracra nial ma s s Ca us e s : AION, e tc

OPTIC DISC OPTIC DISC

Atrophic : Compre s s ion by ma s s P re vious ly a ffe cte d : Atrophic
Ele va te d : Be ca us e of e le va te d ICP Curre ntly involve d : Ede ma tous
Pallor Elevation
 Elevated ICP Ischemic

CS F unde r pre s s ure in s uba ra chnoid

Occlus ion of cilliary a rteriole s
s pa ce compre s s cilliary a rteriole s 
is che mia  a xopla s mic flow
chronic is che mia reta rd a xopla s mic flow
da ms up at s clera l lamina 
a t s cle ra l lamina  dis te ntion of
Optic dis c s we lls
pre la minar RGC a xon
Abnormal Optic Disc
Ischemic Optic Neuropathy
 HVF

30-2 central pattern 10-2 central patten

Number test points : 76 Number of test points : 68
300 from fixation point 100 from fixation point
Distant between points is 60 Distant between points is 20
 HVF

1
Zone 1 : Patient’s data
2 Zone 2 : Reliability criteria
8 Zone 3 : Grey scale
3 Zone 4 : Total deviation plot
4 5 7 Zone 5 : Pattern deviation plot
6 Zone 6 : Global index
Zone 7 : GHT
Zone 8 : Raw score
 Pattern of Visual Field Loss

cecocentral paracentral

nasal step

central arcuate altitudinal

enlarged blind spot
1 2

3 4
mild mod severe
 Fundus Flourescin Angiography
• Photographs of the retina are taken after intravenous injection of sodium
fluorescein
• 80 % fluorescein is protein-bound  not available for fluorescence.
Remaining 20% is unbound  ciculates in the vasculature & tissues of the
retina-rchoroid

• Fluorescein is injected into a peripheral vein and enters the ocular

circulation via ophthalmic artery 8-12 sec later
1) Transit phase (10- 15 sec)  The retinal and choroidal vessels fill
2) Arterial phase  dye fills the retinal arteries
3) Arteriovenous phase / peak phase (1 min)  complete filling of the
retinal arteries and capillaries and concludes with laminar filling of the
retinal veins. The most capillary detail is shown in the fovea
4) Late phase  dye recirculates and fluorescence gradually declines