A 65-year-old gentleman is admitted to the medical take with a progressively worsening headache for 3 weeks. On closer questioning, he reveals it is worse first thing in the morning but also exacerbated by recumbency and coughing. He is also complaining of intermittent visual disturbances and on fundoscopic examination, there is papilloedema of the right disc but optic atrophy on the left.
A subsequent CT scan is performed revealing a space occupying lesion. Where is the space occupying lesion most likely situated?
Left temporal
Right frontal
Right temporal
Left frontal
Left parietal
Dr. Kasper:
Left frontal
This is an interesting case of Foster-Kennedy syndrome. This syndrome reflects a frontal lobe tumour - usually a meningioma in this age group - leading to ipsilateral optic atrophy and papilloedema of the contralateral optic nerve. The reason for the optic atrophy is as a result of direct damage from the space occupying lesion. Other causes are AVMs and juvenile nasopharyngeal angiofibroma.