0:01

This is an MRI of the brain

0:02

in a two-year-old child

0:03

with neurofibromatosis type 1.

0:05

And at this young age,

0:06

we don't see any significant signs

0:08

of myelin vacuolization,

0:10

possibly some subtle findings in the posterior

0:13

aspect of the right globus pallidus.

0:15

And otherwise,

0:17

we're seeing some signal abnormality in the deep

0:20

cerebellar white matter bilaterally.

0:23

Now, the optic nerves at this time

0:28

look normal in caliber.

0:30

They're symmetric in caliber.

0:32

If we look at the post-contrast imaging,

0:36

on the right side,

0:37

we're seeing a possible subtle focus

0:39

of enhancement in the posterior orbital

0:41

segment of the right optic nerve.

0:43

But there's no significant tortuosity.

0:45

And this could easily be written off

0:48

as possible artifact or a passing vessel.

0:53

But we know that patients

0:54

with neurofibromatosis type 1

0:56

have a significant

0:57

predisposition to optic pathway tumors.

1:00

Well,

1:02

if we fast forward about seven or eight years,

1:06

we can see there is asymmetric thickening of

1:11

the right optic nerve throughout

1:13

the entire orbital segment.

1:15

We can see there's more tortuosity of the

1:17

right optic nerve than the left because

1:19

it goes out of plane and into plane.

1:22

And this coronal image shows the fusiform

1:27

enlargement of the right optic nerve

1:29

as compared to the left.

1:32

So, what started off as a subtle enhancement

1:37

over eight or nine years becomes

1:40

a very clear fusiform glioma.

1:42

We don't know how every lesion will evolve.

1:45

Some will get bigger over time.

1:47

Some areas of enhancement in signal

1:49

abnormality may dissipate,

1:52

and some may stay the same.

1:54

We don't know.

1:55

But these are the types of findings that we're

1:57

being asked to look for and being aware that

2:01

not just an optic pathway glioma

2:03

can occur in NF 1,

2:05

but how it may look when it's more subtle,

2:08

how it may evolve is important,

2:10

and that's what my hopes are

2:12

in showing this case.