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Strabismus and diplopia in a patient with acute myeloid leukemia

Fozza, Claudio and Dore, Fausto and Isoni, Maria Antonia and Longu, Francesco and Dessì, Laura and Coppola, Lorenzo and Contini, Salvatore and Longinotti, Maurizio Roberto (2014) Strabismus and diplopia in a patient with acute myeloid leukemia. The American Journal of Case Reports . eISSN 1941-5923. Article.

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DOI: 10.12659/AJCR.890526

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Abstract

Background: Central nervous system (CNS) involvement is a sporadic presenting finding in patients with acute myeloid leukemia (AML) both at diagnosis and at relapse. Moreover patients with CNS localization are often asymptomatic, while sometimes show meningeal signs and symptoms or, extremely rarely, signs of cranial nerve impairment.
Case Report: Here we report on a patient with refractory AML who suddenly developed strabismus and diplopia. Both neurological and ophtalmologic examinations were suggestive of a bilateral VI cranial nerve palsy. Noteworthy, both a cranial CT and MRI were substantially normal, while a rachicentesis was performed and cerebrospinal fluid examination was clearly suggestive of a meningeal involvement by AML.
Conclusions: This is to our knowledge the first reported case in which the clinical picture of meningeal localization in an AML patient was dominated by an isolated abducens cranial nerve impairment. Moreover it highlights as unexplained strabismus and diplopia can be considered as a potential sign of CNS involvement, even if conventional imaging is negative.

Item Type:Article
ID Code:9956
Status:Published
Refereed:Yes
Uncontrolled Keywords:Cranial Nerve Diseases, diplopia, leukemia, myeloid, acute, cerebrospinal fluid
Subjects:Area 06 - Scienze mediche > MED/15 Malattie del sangue
Divisions:001 Università di Sassari > 01-a Nuovi Dipartimenti dal 2012 > Scienze Biomediche
001 Università di Sassari > 01-a Nuovi Dipartimenti dal 2012 > Medicina Clinica e Sperimentale
Publisher:International Scientific Literature
eISSN:1941-5923
Deposited On:09 Jul 2014 08:50

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