Progressive Double Arcuate Scotoma is a Rare Presentation in Falx Meningioma Cerebri

Abstract

A 77-year-old woman with multiple comorbidities, who is a glaucoma suspect, presented with a progression of a double arcuate visual filed defect over a five-month period. The intraocular pressure was within normal limit, and the cup-to-disc ratio was between 0.6 to 0.7 in both eyes. A computed tomography (CT) scan of the brain revealed a large, well-circumsribed hyperdense mass in the right occipital lobe, with heterogenous enhancement post-contrast and obliteration of the third ventricle. Magnetic resonance imaging (MRI) showed a well-defined, extra-axial, rounded mass in the right parieto-occipital region, with a cerebrospinal fluid cleft, a dural tail sign and broad base consistent with a right parieto-occipital falx meningioma. The patient was advised to undergo surgical removal of the mass; however, she declined due to her advanced age and the absence of neurological abnormalities, except for the visual field defect. In conclusion, a high index of suspicion is warranted in patients who are glaucoma suspects and present with progressive visual field defects. A progressive double arcuate visual field defect may indicate an underlying silent occipital pathology.