Foster Kennedy Syndrome

Synonyms: Kennedy's phenomenon; Gowers-Paton-Kennedy syndrome

This is a rare neurological sign first described in 1911 by Robert Foster Kennedy.¹ He was a British neurologist, who spent the majority of his working life in America (1884-1952). It consists of:

• Unilateral, ipsilateral optic atrophy, produced by direct pressure on the optic nerve
• Contralateral papilloedema secondary to raised intracranial pressure (ICP)
• Central scotoma
• Anosmia

It is most commonly caused by a tumour on the inferior surface of the frontal lobe. This is usually an olfactory groove meningioma or a medial third sphenoidal wing meningioma. It has also been reported as a consequence of a metastatic cerebral tumour.²

A review of the 36 previously reported cases of Foster Kennedy Syndrome (FKS) revealed that only eight (22%) of the cases satisfied Foster Kennedy's original hypothesis for the pathogenesis of his syndrome. 12 cases (33%) were probably caused by bilateral optic nerve compression.³ The authors conclude that as more sophisticated imaging permits earlier and more precise diagnosis, future cases of FKS caused by a mass will probably be found to result from bilateral direct optic nerve compression.

These include:

• Nausea
• Vomiting
• Memory loss
• Emotional lability i.e. other frontal lobe signs

Both depend on the underlying tumour.