Chronic Myelogenous Leukemia Relapse Presenting With Central Nervous System Blast Crisis and Bilateral Optic Nerve Infiltration

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Title Chronic Myelogenous Leukemia Relapse Presenting With Central Nervous System Blast Crisis and Bilateral Optic Nerve Infiltration
Creator Joyce N. Mbekeani, MD, FRCS, FRCOphth; Maaly Abdel Fattah, MD, PhD; Randa M. Al Nounou, MD; Wahiba Chebbo, MD; Mohammed Asif Dogar, MD
Affiliation Department of Surgery (JNM), North Bronx Health Network, Bronx, New York; Department of Ophthalmology & Visual Sciences (JNM), Albert Einstein College of Medicine of Yeshiva University, New York; Department of Ophthalmology (MAF), King Faisal Specialist Hospital & Research Center, Riyadh; Department of Ophthalmology (MAF), Cairo University Medical School, Cairo, Egypt; Department of Hematologic Pathology (RMAN), King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; Department of Hematology-Oncology (WC), King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia; and Department of Neuro-Radiology (MAD), King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
Abstract To describe the history, clinical findings, and possible pathogenic etiologies of the constellation of neuro-ophthalmic findings discovered in astronauts after long-duration space flight and to discuss the terrestrial implications of such findings.; ; Retrospective review of published observational, longitudinal examination of neuro-ophthalmic findings in astronauts after long-duration space flight; analysis of postflight questionnaires regarding in-flight vision changes in approximately 300 additional astronauts; and hypothesis generating for developing possible future countermeasures and potential implications for neuro-ophthalmic disorders on Earth. Astronauts with neuro-ophthalmic findings, which were not present at the start of a space flight mission and only seen on return from long-duration space missions to the International Space Station, will be discussed.; ; After 6 months of space flight, 7 astronauts had ophthalmic findings consisting of optic disc edema in 5, globe flattening in 5, choroidal folds in 5, cotton-wool spots in 3, nerve fiber layer thickening detected by optical coherence tomography in 6, and decreased near vision in 6. Five of 7 astronauts with near vision complaints had a hyperopic shift ≥+0.50 diopters (D) between pre-/post-mission spherical equivalent refraction in 1 or both eyes (range, +0.50 to +1.75 D). These 5 astronauts showed globe flattening on magnetic resonance imaging. A total of 6 lumbar punctures have been performed to date (4 in the originally described cohort) and documented opening pressures of 18, 22, 21, 21.5, 28, and 28.5 cm H2O. These were performed at 8, 66, 19, 7, 12, and 57 days after mission, respectively. The 300 postflight questionnaires documented that approximately 29% and 60% of astronauts on short-duration and long-duration missions, respectively, experienced a degradation in distant and near visual acuity. Some of these vision changes remain unresolved for years after flight. Several possible pathogenic mechanisms, as well as potential countermeasures and discussion of possible terrestrial implications, are described.; ; We previously hypothesized that the optic nerve and ocular changes that we described in astronauts may be the result of orbital and cranial cephalad fluid shifts brought about by prolonged microgravity exposure. The findings we reported previously and continue to see in astronauts may represent parts of a spectrum of ocular and cerebral responses to extended microgravity exposure. Future investigations hopefully will lead to countermeasures that can be used to eliminate or lessen the magnitude of these potentially harmful findings before long-duration space flight including the possibility of a manned mission to Mars.
Subject Antineoplastic Combined Chemotherapy Protocols; Blast Crisis; Female; Genes, abl; Humans; In Situ Hybridization, Fluorescence; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Leukemic Infiltration; Magnetic Resonance Imaging; Middle Older people; Neoplasm Recurrence, Local; Optic Nerve Neoplasms; Real-Time Polymerase Chain Reaction; Salvage Therapy; Tomography, Optical Coherence
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Date 2016-03
Language eng
Format application/pdf
Type Text
Publication Type Journal Article
Collection Neuro-Ophthalmology Virtual Education Library: Journal of Neuro-Ophthalmology Archives: https://novel.utah.edu/jno/
Publisher Lippincott, Williams & Wilkins
Holding Institution Spencer S. Eccles Health Sciences Library, University of Utah
Rights Management © North American Neuro-Ophthalmology Society
ARK ark:/87278/s6x965sn
Setname ehsl_novel_jno
ID 1276461
Reference URL https://collections.lib.utah.edu/ark:/87278/s6x965sn
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