Visual Impairment in Ghanaian Patients with Brain Tumours, Factors Affecting This and Their Prognostic Significance

Abstract

Background: Anecdotally, Ghanaians with brain tumours present late with visual impairment. Contributory factors are unclear.
Purpose: To determine the degree of visual impairment in Ghanaians with brain tumours, factors affecting this and their prognostic significance.
Methods: A prospective study of 70 consecutive patients newly diagnosed with brain tumours seen from November 2010 to July 2013, at Korle-Bu Teaching Hospital(KBTH), Accra, Ghana. Patients had clinical diagnosis of brain tumour with confirmation by Computerized tomography(CT) or Magnetic Resonance Imaging(MRI).
Outcome measures: presenting visual acuity, prepresentation symptom interval (PPSI), tumour size and location at presentation.
Results: Data on 70 patients was analyzed. Ages ranged from 8 days to 70 years, mean(SD) 41.8±1.8. Fortyseven (67.1%) were females. Histology was confirmed in 22(75.9%) of 29 who had surgery, comprising: pituitary adenoma, 17(77.3%) meningioma, 2(9.1%)
craniopharyngioma, 2(9.1%) and combined pituitary adenoma and meningioma,1(4.5%). Common presenting symptoms were blurred vision, 65(92.9%), headache, 51(72.9%) and ocular pain, 22(31.4%). Common signs were impaired colour vision in 97(79.5%) of 122 eyes and optic atrophy in 49(35%) of 140 eyes. Fourteen (20%) patients were visually impaired and 18(25.7%) blind. Visual impairment
20(14.3%) and blindness, 61(43.6%) were present in 140 eyes. Pre-presentation symptom interval(PPSI) was longer in the blind than the visually impaired. However, no significant association was found between PPSI and visual impairment or blindness (p=0.660). No
association was found between diagnosis and visual status at presentation (p=0.629)
Conclusions: Early detection of brain tumours to avoid blindness and visual impairment is needed in this population since majority (57.9%) of eyes were blind or visually impaired at presentation.