Bilateral optic nerve sheath calcifications (ct scan). - Case Details

CT Scan

CT (brain window) red arrows show optic nerve sheath calcifications; green arrows show normal posterior fossa.

CT (bone window) – red arrows highlight optic sheath calcifications; green arrows show normal brain tissue.

Coronal CT – red arrows mark optic nerve sheath calcifications.

Abdominal CT – white arrows indicate CKD renal changes.

Title: Bilateral Optic Nerve Sheath Calcifications (CT scan).
Diagnosis Title: Secondary Hyperparathyroidism with Orbital Calcification in CKD.
Disease Specialty: Nephrology
Ease of Diagnosis: Difficult
Certainty: Certain
Ethnicity: Asian
Segment: Adult Male
Image Quality: Medium
Clinical Examination: Bilateral vision loss (amaurosis), normal fundoscopy, CT shows optic nerve sheath calcifications.
Patient Age: 66 Year
Patient Gender: Male

A 66 year old man with CKD on hemodialysis presented with bilateral amaurosis for 2 months. Fundoscopy was normal. CT revealed bilateral optic nerve sheath calcifications. Labs: PTH 105 pg/mL, Ca 12.5 mg/dL, PO₄ 3.8 mg/dL, ALP 192 U/L, 25-OH vitamin D 17 ng/mL. Suggests CKD-related mineral and bone disorder with rare orbital manifestation. Differentials: meningioma, glioma, phthisis bulbi, prior hemorrhage.