Disclosures: Eric A. Liu, DO: No financial relationships or conflicts of interest

Case Description: An 82-year-old female with history of rheumatoid arthritis and left eye impairment secondary to glaucoma and cataracts presented to the acute care hospital for acute bilateral vision loss. She first noticed visual changes five days prior and was evaluated by an ophthalmologist outpatient. Examination was reportedly normal. Labs were significant for elevated CRP and ESR, and she was referred to the ED for concern of giant cell arteritis. IV steroids were started and bilateral temporal artery biopsies were obtained. MRI brain revealed an enhancing mass consistent with a meningioma. She underwent right frontal craniotomy and resection.

Setting: Academic Inpatient Rehabilitation Hospital

Patient: 82-year-old female who presents with bilateral vision loss and elevated CRP and ESR Assessment/

Results: Following resection, there was significant improvement in visual acuity bilaterally. Fundoscopic examination showed pale optic disks consistent with optic neuropathy secondary to compression. Temporal artery biopsies were negative. She was admitted to acute inpatient rehabilitation and discharged home at a functional level of close supervision for ADLs, transfers, and ambulation.

Discussion: Progressive vision loss is cited as the most frequent initial complaint and can present unilaterally or bilaterally. In this case, the patient had pre-existing left eye impairment before presenting with acute bilateral vision loss in the setting of elevated CRP and ESR. Although initial presentation suggested giant cell arteritis, further workup revealed a suprasellar mass and appropriate management was applied. Literature review showed favorable prognosis is associated with a duration of symptoms less than 2 years emphasizing the importance of early diagnosis.

Conclusion: While giant cell arteritis typically presents as progressive visual loss, suprasellar meningiomas should still be considered in patients who present with sudden loss of vision. This case emphasizes the importance of keeping suprasellar meningiomas in the differential for acute visual defects in hopes that clinicians can arrive at an earlier diagnosis and have improved outcomes.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/suprasellar-meningioma-masquerading-as-giant-cell-arteritis-a-case-report/