This patient with typical skin findings of neurofibromatosis type 1 (café au lait spots, axillary freckling, multiple cutaneous neurofibromata), was referred with concern about reduced visual acuity.

MRI head and spine demonstrated optic pathway glioma, multiple nerve root neurofibromata and dural ectasia, all consistent with NF1. These findings have not changed on follow-up and remain under radiological and clinical review.

The bladder wall thickening detected on MR was confirmed to be ganglioneuroma on biopsy and managed conservatively.