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Bilateral Optic Nerve Sheath Calcifications (CT scan).
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Mar 24, 2026
  • 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.
     

    CT Scan
    CT (brain window) red arrows show optic nerve sheath calcifications; green arrows show normal posterior fossa.
    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.
    CT (bone window) – red arrows highlight optic sheath calcifications; green arrows show normal brain tissue.
    Coronal CT – red arrows mark optic nerve sheath calcifications.
    Coronal CT – red arrows mark optic nerve sheath calcifications.
    Abdominal CT – white arrows indicate CKD renal changes.
    Abdominal CT – white arrows indicate CKD renal changes.