Late adult onset optic pathway astrocytoma.

A 70-year-old man presented with left-sided eye pain, impaired vision and restricted left ocular motility, later developing progressive visual decline with development of ataxia and incontinence. Fundoscopic examination revealed significant optic nerve head edema and hemorrhage on the left eye. Neuroimaging revealed an optic pathway mass, extending from the right optic nerve to the chiasm, which enlarged on serial imaging. After surgical excision of the mass, pathology showed a grade III astrocytoma. The patient died 16 months after presentation, which is longer than previously reported for late adult onset optic pathway astrocytoma. We believe that neuroimaging and pathological studies should be performed early in such patients to allow early diagnosis and intervention.