Based on the pathogenic mechanism, three types of Foster-Kennedy syndromes have been described [1]:

1. Type 1 – only one optic nerve is directly compressed and intracranial hypertension is present
2. Type 2 – compression of bilateral, optic nerves asymmetrically; the nerve which is more severely compressed becomes atrophied, while the other, less compressed nerve leads to papilledema
3. Type 3 – the nerves are not directly compressed by the tumor, their damage is due to chronic intracranial hypertension.

The most prominent symptoms are, as expected, visual: unilateral or bilateral vision loss that, if left untreated, becomes permanent in time, visual field defects, reduced color vision, and central scotoma. Visual obscurations may also be temporary when intracranial or systemic blood pressure is transiently decreased. Symptoms regress if early treatment is applied [2] [3]. Associated symptoms include nausea and vomiting as signs of intracranial hypertension [4], memory loss and emotional lability as an expression of frontal lobe involvement. Headaches and weakness may complete the clinical picture, which is slightly variable depending on the location of the pathological process [5] and pathogenic mechanism [6] [7].

• Lymphadenopathy

  There was no significant lymphadenopathy. There was no dependent oedema. Naso-pharyngeal examination did not reveal any abnormality. Respiratory system and cardiovascular system did not reveal any abnormality. The liver and spleen were not palpable. [ijo.in]

• Anosmia

  Tumor at the base of the frontal lobe produces inappropriate behavior, optic nerve atrophy on the side of the tumor, papilledema on the other side, and anosmia (Foster- Kennedy syndrome). [en.wikipedia.org]

  Foster Kennedy syndrome is a very rare syndrome which includes ipsilateral optic atrophy and central scotoma, anosmia, contralateral papilledema, and, occasionally, ipsilateral proptosis. [ncbi.nlm.nih.gov]

  - ipsilateral optic atrophy - ipsilateral anosmia - raised icp (papilledema in the contralateral eye, nausea, vomiting,...) due to frontal mass. typically olphatory groove meningioma 26 8 Reply optic atrophy and anosmia due to compression of optic and [dailyrounds.org]

• Hyposmia

  Vitamin A deficiency is associated with hyposmia and dysosmia (odors are unpleasant), possibly the result of nasal mucosal abnormalities. c. Zinc deficiency has been associated with hyposmia and dysosmia. d. Diabetes mellitus. [dartmouth.edu]

• Central Scotoma

  Foster Kennedy syndrome is a very rare syndrome which includes ipsilateral optic atrophy and central scotoma, anosmia, contralateral papilledema, and, occasionally, ipsilateral proptosis. [ncbi.nlm.nih.gov]

  Ken·ne·dy syn·drome ( ken'ĕ-dē ), ipsilateral optic atrophy with central scotoma and contralateral choked disc or papilledema, caused by a meningioma of the ipsilateral optic nerve. [medical-dictionary.thefreedictionary.com]

  The syndrome is defined as the following changes: optic atrophy in the ipsilateral eye disc edema in the contralateral eye central scotoma (loss of vision in the middle of the visual fields) in the ipsilateral eye anosmia (loss of smell) ipsilaterallyThis [en.wikipedia.org]

• Diplopia

  A 44-year-old man was examined for headache and diplopia. Left eye showed limitation of abduction. Ocular fundus, computed tomography (CT), and magnetic resonance imaging (MRI) of the head and orbits were normal. The diplopia subsided spontaneously. [ncbi.nlm.nih.gov]

  The diplopia subsided spontaneously. Sixmonths later, he noticed sudden visual loss in the left eye.The left eye showed optic disk atrophy and episcleritis,and the right eye showed papilloedema. [docslide.com.br]

  headache diplopia, nausea and vomiting) [6] Family members may report personality changes Figure 2 : Patterns of visual field loss in optic neuropathies. A. OD: Paracentral scotoma OS: Cecocentral scotoma. B. Central scotoma. C. Arcuate scotoma. [eyewiki.aao.org]

• Flame-shaped Hemorrhage

  Initial presentation of the right optic nerve head showed disc edema, peripapillary flame shaped hemorrhages, nerve fi ber layer attenuation, venular distention, and partial macular star. [mjdrdypu.org]

• Papilledema

  Clinical findings included papilledema in the right eye and optic atrophy in the left eye. A diagnosis of Foster Kennedy syndrome was made. [ncbi.nlm.nih.gov]

  Pseudo-Foster Kennedy syndrome is defined as one-sided optic atrophy with papilledema in the other eye but with the absence of a mass. [en.wikipedia.org]

  Foster-Kennedy syndrome Syndrome (see: Disease) Papilledema(choked disc) Parent Code: H47.1 - Papilledema [icd.codes]

  Foster Kennedy syndrome describes the clinical syndrome of unilateral optic atrophy with contralateral papilledema caused by an ipsilateral compressive mass lesion. [radiopaedia.org]

• Generalized Tonic-Clonic Seizure

  In December 1987, after a generalized tonic-clonic seizure, she was found to have a large right frontoparietal mass without direct impingement on the optic nerves, or chiasm on neuroradiological studies. [ncbi.nlm.nih.gov]

• Altered Mental Status

  May also present with symptoms related to pre-frontal cortex involvment like desinhibition, emotional lability, altered mental status 14 Reply I agree with the diagnosis. 1 Reply Foster Kennedy syndrome is Ipsilateral optic nerve atrophy. ipsilateral [dailyrounds.org]

Workup aims to identify the pathological process leading to the appearance of Foster-Kennedy syndrome and to evaluate the extent of optic nerve damage. Thus, computer tomography (CT) [8] and magnetic resonance imaging (MRI) of the brain are useful tools [9]. CT is optimum when trying to determine bone involvement and thus predict recurrence risk, whereas MRI better describes soft tissues.

Ocular evaluation should include fundus examination to determine the degree of papillary edema and observe disk swelling or pallor, nerve fiber layer evaluation with red-free light, color vision test, capillary number test (less than 10 capillaries on the optic disk suggest optic atrophy) and electrophysiological tests, in cases where symptoms do not match disk pallor. The assessment of the electrical activity of the visual cortex after retinal stimulation comprises two parameters, amplitude, and latency, both of which are affected due to optic nerve malfunction. Pupillary reflexes assessment should also be performed.

• Central Scotoma

  Foster Kennedy syndrome is a very rare syndrome which includes ipsilateral optic atrophy and central scotoma, anosmia, contralateral papilledema, and, occasionally, ipsilateral proptosis. [ncbi.nlm.nih.gov]

  Ken·ne·dy syn·drome ( ken'ĕ-dē ), ipsilateral optic atrophy with central scotoma and contralateral choked disc or papilledema, caused by a meningioma of the ipsilateral optic nerve. [medical-dictionary.thefreedictionary.com]

  The syndrome is defined as the following changes: optic atrophy in the ipsilateral eye disc edema in the contralateral eye central scotoma (loss of vision in the middle of the visual fields) in the ipsilateral eye anosmia (loss of smell) ipsilaterallyThis [en.wikipedia.org]

1. Watnick RL, Trobe JD. Bilateral optic nerve compression as a mechanism for the Foster Kennedy Syndrome. Ophthalmology. 1989;96(12):1793–1798.
2. Bulters DO, Shenouda E, Evans BT, et al. Visual recovery following optic nerve decompression for chronic compressive neuropathy. Acta Neurochir. 2009;151:32
3. Fogarty-Mack P, Pile-Spellman J, Hacein-Bey L, et al. The effect of arteriovenous malformations on the distribution of intracerebral arterial pressures. Am J Neuroradiol. 1996;17:1443–1449.
4. Biousse V, Bousser MG. L'hypertension intracrânienne bénigne. Rev Neurol. 2001;157:21–34.
5. Lotfipour S, Chiles K, Kahn JA, et al. An unusual presentation of subfrontal meningioma: a case report and literature review for Foster Kennedy syndrome. Intern Emerg Med. 2011;6:267–269.
6. Ruben S, Elston J, Hayward R. Pituitary adenoma presenting as the FosterKennedy syndrome. Br J Ophthalmol. 1992;76:117–119.
7. Walia HS, Grumbine FL, Sawhney GK, et al. An aggressive sphenoid wing meningioma causing Foster Kennedy syndrome. Case Rep Ophthalmol Med. 2012;102365.
8. Jarus GD, Feldon SE. Clinical and computed tomographic findings in the Foster Kennedy Syndrome. Am J Ophthal. 1982;93:317–322.
9. Fogarty-Mack P, Pile-Spellman J, Hacein-Bey L, et al. The effect of arteriovenous malformations on the distribution of intracerebral arterial pressures. Am J Neuroradiol. 1996;17:1443–1449.