The true Foster Kennedy syndrome:
• subfrontal lobe mass that causes compression of one optic nerve with a subsequent loss of vision and optic atrophy.
• As the tumor grows, it causes a second problem, increased intracranial pressure and papilledema.
•the optic disc of the eye that had suffered compression and usually is atrophic can no longer swell and so remains unchanged as a pale disc with sharp margins.
• The other disc develops the pink swelling of acute and subacute papilledema with headache
The pseudo Foster Kennedy syndrome:
• bilateral episodes of anterior ischemic optic neuropathy separated by at least several months.
•On examination, a sharp pale disc in the eye that had the first attack of anterior ischemic optic neuropathy.
• the eye with the new onset ischemic optic neuropathy, the swollen disc ( pale or pink).
• whereas in the true Foster Kennedy syndrome, the swollen disc is usually pink( change to pale if persist which not usually seen as patient seek medical advice before , from headache )
• both syndromes present with one swollen disc and another that is sharp and pale. If the swollen disc is pink( true and pseudo syndrome suspected)
• if The swollen disc is pale , pseudo Foster Kennedy syndrome is more susceptible .
• Two separate acute attacks of sudden visual loss is the hallmark of the pseudo Foster Kennedy syndrome.
• A progressive visual loss in one eye means a true Foster Kennedy syndrome.
• the pseudo Foster Kennedy syndrome is many times more frequent than the true one.
• Don’t forget that pseudo syndrome can be seen in cases of increased ICT without MRI evidence of a tumor
True and Pseudo Foster Kennedy Syndromes Videos:
What Is The Treatment For Foster Kennedy Syndrome?
https://www.youtube.com/watch?v=OnZBVamIFkE
True and Pseudo Foster Kennedy Syndromes PowerPoint presentation :
DD of disc edema
1. Guide: Dr Anupama Karanth Presenter: Dr Madhurima
2. Causes of pseudo disc edema • Optic nerve head drusen : disc elevation • Medullated nerve fibres : blurred margins • Morning glory syndrome: elevated disc • Tilted disc: blurred margins • Small hyperopic disc: hyperemic disc • Optic disc dysplasia • Bergmeister’s papilla
3. True disc edema Pseudo disc edema Disc color Hyperemic Yellow Nerve fibre layer Opacified Transparent Large vessels Normal Anomalous- trifurcation, spoke like Small vessels Telangiectatic Normal
4. True disc edema Pseudo disc edema Spontaneous venous pulsation Absent Present in 80% Hyaline bodies Absent May be present Optic cup Normal initially, filled Small or absent Nerve fibre layer hemorrhages Frequent Absent Fluorescein angiography Dye leakage at disc No leakage/ late staining
5. • Hyaline like calcific material in the substance of optic nerve head, autofluorescence, trifurcation of vessels • Causes disc edema if buried, diagnosed by B Scan
6. • Obliquely entering nerve, inferonasal chorioretinal thinning • Bitemporal hemianopia Blurred margin Nasally entering vessels
7. Large disc with funnel shaped excavation surrounded by chorioretinal atrophy, with central tuft of white material Spoke like vessels Elevated disc Hyperemic
8. Presence of feathery grey streaks may simulate disc edema, but distal fan shaped appearance aids recognition Feathery streaks Margins blurred, disc elevated
9. Mechanical signs Elevation of the optic disc (3D=1mm) Blurring of the optic disc margins Filling in of optic cup Edema of peripapillary nerve fiber Retinal or choroidal folds Vascular signs Hyperemia of disc Venous congestion Peripapillary hemorrhages Exudates in disc or peripapillary area Nerve fiber layer infarcts
10. Diagnosis is done best by binocular stereoscopic viewing using a high convex lens, with magnification especially to detect the subtle changes in disc elevation.
11. Once true disc edema is established, papilledema (due to raised ICT) has to be distinguished from other optic neuropathies which can be of varied etiology The main difference is visual acuity and optic nerve function which is normal in papilledema and disturbed in papillitis.
True and Pseudo Foster Kennedy Syndromes
