(CR24) Pseudo Foster Kennedy Syndrome (PFKS) With Macular Star : A Diagnostic Dilemma

Introduction:

FKS is characterized by unilateral optic atrophy with contralateral optic disc edema. Here we describe a case of pseudo-FKS with macular star in sequential non arteritic ischaemic optic neuropathy (NAION).

Case Presentation :

A 67 years old gentleman presented with both eyes painless blurring of vision for 1 month, right eye followed by left eye.  Patient has underlying diabetes mellitus, hypertension and hyperlipidemia.On examination, right eye vision 6/60 and left eye counting finger. Anterior segment examination was unremarkable. Fundus examination of the right eye revealed a pale optic disc ,while left eye revealed a swollen optic disc with peripapillary hemorrhages and macula star. Blood pressure was 210/120mmHg, and sugar level was 8.7mmol/L .OCT macula showed normal right eye and left eye subretinal fluid.Infective screening for tuberculosis and bartonella was negative, and tumor markers screening for malignancy was unremarkable. Contrast enhanced computed tomography (CECT) Brain done showed no evidence of space occupying lesion. A diagnosis of sequential NAION was made,  and patient’s medical conditions was optimized. On follow up after 6 months, despite of optimization of his medical condition, his visual acuity remains poor with visual acuity of 6/60 on the right eye, and 6/120 on the left eye. Fundus examination showed bilateral optic atrophy with dull fovea reflex.

Conclusion :

Foster Kennedy syndrome with macula star may pose a diagnostic challenge. Causes of raised intracranial pressure either infective or non-infective need to be ruled out. Sequential NAION  is diagnosis of exclusion that may occur in elderly with vasculopathic risk factors.