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Ocular System

Foster Kennedy syndrome

Rare clinical syndrome in which an anterior intracranial mass directly compresses the ipsilateral optic nerve, causing atrophy, and increases intracranial pressure, which results in contralateral papilledema.

Rare clinical syndrome in which an anterior intracranial mass directly compresses the ipsilateral optic nerve, causing atrophy, and increases intracranial pressure, which results in contralateral papilledema.

History:

The syndrome was first extensively noted by Robert Foster Kennedy in 1911, an Irish neurologist, who spent most of his career working in the United States of America. However, the first mention of the syndrome came from a William Gowers in 1893. Schultz–Zehden described the symptoms again in 1905. A later description was written by Wilhelm Uhthoff in 1915.

  • Further details: Lai, Ang-Ting; Chiu, Shin-Lin; Lin, I-Ching MD; Sanders, Michael FRCS, FRCP, FRCOpht Foster Kennedy Syndrome: Now and Then, Journal of Neuro-Ophthalmology: March 2014 – Volume 34 – Issue 1 – p 92-94 doi: 10.1097/WNO.0000000000000072

Diagnosis

Fundus examination:

Funduscopy in a 36-year-old man with headaches and loss of vision. (A) Edema of the optic disk (arrows) in the chronic phase (“champagne cork”) is visible in the right fundus, with venous tortuosity and dilatation (arrowheads). (B) Left funduscopy shows a pale optic disk, consistent with axonal death. The lack of colour is more marked in the temporal area (arrows). | Pastora-Salvador, N., & Peralta-Calvo, J. (2011). Foster Kennedy syndrome: papilledema in one eye with optic atrophy in the other eye. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 183(18), 2135. https://doi.org/10.1503/cmaj.101937

MRI:

Precontrast T1 axial (A) and coronal (B) magnetic resonance imaging shows a large tumour mass causing left to right shift with ventricular obstruction and compression of the prechiasmal portion of the left optic nerve (arrow). C. Postcontrast T1 axial scan reveals tumour enhancement and left optic nerve compression (arrow). | Lai, Ang-Ting; Chiu, Shin-Lin; Lin, I-Ching MD; Sanders, Michael FRCS, FRCP, FRCOpht Foster Kennedy Syndrome: Now and Then, Journal of Neuro-Ophthalmology: March 2014 – Volume 34 – Issue 1 – p 92-94 doi: 10.1097/WNO.0000000000000072

Differential diagnosis

Pseudo-Foster Kennedy syndrome:

Presence of above clinical findings, in the absence of an intracranial mass
  • Aetiology:
    • Nonarteritic anterior ischemic optic neuropathy (NAION)
    • Arteritic anterior ischemic optic neuropathy (AAION)

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