Background: Malignant optic gliomas of adulthood are aggressive tumors that arise in the anterior visual pathway, typically starting in one optic nerve and rapidly extending to the optic chiasm and optic tracts. The initial symptom is usually unilateral visual loss. Prognosis is poor.
Case Report: A 53 year old woman noted difficulty reading and visual blur in both eyes. A right homonymous hemianopic visual field defect was noted. MRI revealed marked enlargement and enhancement of nearly the entire intracranial portion of the anterior visual pathway (optic nerves, chiasm and optic tracts) as well as a lesion in the deep white matter. The patient progressively lost vision and died eight months after initial consultation. Diagnosis of multicentric malignant glioma was confirmed at autopsy.
Conclusions: A homonymous hemianopia is a rare but recognized presenting sign of malignant optic gliomas of adulthood.

Keywords: optic tract, Optic Nerve Glioma - diagnosis, homonymous hemianopia, optic chiasm