A PRESENTATION OF PSEUDO-FOSTER KENNEDY SYNDROME
IN UNDIAGNOSED DIABETES MELLITUS AND DYSLIPIDEMIA
Sri Hudaya Widihastha 1, Rusti Hanindya Sari 2, Antonia Kartika 2, Dianita Veulina 2
1 Department of Ophthalmology, National Eye Center Cicendo Eye Hospital/Universitas Padjadjaran, Bandung
2
Neuro-ophthalmology Unit, National Eye Center Cicendo Eye Hospital, Bandung
INTRODUCTION
Pseudo-Foster Kennedy Syndrome is described as unilateral optic disc
swelling with contralateral optic atrophy in the absence of an
intracranial mass. We report a case of Pseudo-Foster Kennedy
syndrome in patient with untreated Diabetes Mellitus and dyslipidemia.
A 54-year-old male came with a chief complaint of painless blurred vision in
CASE ILLUSTRATION
the left eye (LE) started one week ago and in the right eye (RE) started two
months ago. He has had history of treated hypertension since 10 years ago.
Visual acuity of the RE was 2/60 and LE was 0.63. Relative afferent pupillary
defect was observed on the RE.
The funduscopy examination revealed optic disc pallor on the RE and optic
disc swelling with peripapillary hemorrhage on the LE. Optical coherence
tomography (OCT) showed retinal nerve fiber layer (RNFL) thinning on the
RE and thickening on the LE.
Laboratory examination showed fasting and two hours post prandial blood
sugar level of 290 mg/dl and 440 mg/dl, respectively. Total cholesterol were
310 mg/dl.
Magnetic resonance imaging showed there was no signs of cerebral infarct
or space occupying lesion. Patient was diagnosed with Pseudo-Foster
Kennedy Syndrome caused by ischemic optic neuropathy.
Further management was systemic regulation and neuroprotective agent.
DISCUSSION
Pseudo-Foster Kennedy Syndrome typically occur due to bilateral sequential non-arteritic
anterior ischemic optic neuropathy (NAION). Identification of risk factors associated with NAION
such as DM and dyslipidemia is mandatory. The most important management in NAION is
modification of systemic risk factors.
CONCLUSION
Pseudo-foster Kennedy Syndrome may
occur due to uncontrolled systemic
disease, such as diabetes mellitus and
dyslipidemia.
Figure 1. Fundus Photograph of RE showed optic disc pallor and OCT
examination on RE showed sectoral RNFL thinning (87 μm)
REFERENCES
1. Patil, A., Takkar, A., Goyal, M., Singh, R., Lal, V. Sequential NAION presenting as
pseudo Foster Kennedy syndrome. Journal of the Neurological Sciences. 2017;
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2. Cestari, D. M., Gaier, E. D., Bouzika, P., Blachley, T. S., De Lott, L. B., Rizzo, J. F., et al.
Demographic, systemic, and ocular factors associated with nonarteritic anterior
ischemic optic neuropathy. 2016; 123 (12), 2446-2455
3. Berry, S., Lin, W. V., Sadaka, A., & Lee, A. G. Nonarteritic anterior ischemic optic
neuropathy: cause, effect, and management. Eye and Brain. 2017; 9, 23.
Figure 2. Fundus Photograph of LE showed optic disc swelling with
peripapillary hemorrhage and OCT examination on LE showed RNFL Pseudo-foster Kennedy Syndrome, diabetes
thickening (131 μm) KEYWORDS: mellitus, dyslipidemia, non-arteritic anterior
ischemic optic neuropathy