Acute Sixth Nerve Palsy and Retinal Hemorrhages as the Presenting Features of Acute Lymphoblastic Leukemia

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Title Acute Sixth Nerve Palsy and Retinal Hemorrhages as the Presenting Features of Acute Lymphoblastic Leukemia
Creator Malek A. Alrobaian; Maria Adelita Vizcaino; Amanda D. Henderson
Affiliation Division of Neuro-Ophthalmology (MA, ADH), Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Ophthalmology (MA), King Abdulaziz Medical City, Riyadh, Saudi Arabia; and Department of Pathology (MAV), Johns Hopkins University School of Medicine, Baltimore, Maryland
Abstract A 36-year-old apparently healthy man presented with acute onset of diplopia. Examination demonstrated left sixth nerve palsy with 3 retinal hemorrhages noted in one eye. Gadolinium-enhanced high-resolution skull base MRI revealed left sixth nerve enhancement involving the cisternal segment. Complete blood count, cerebrospinal fluid analysis, bone marrow biopsy, and flow cytometry confirmed acute T-cell lymphoblastic leukemia with central nervous system involvement. This case demonstrates the value of high-resolution MRI in the evaluation of cranial nerve palsy in young adults and also emphasizes the importance of systemic work up in these cases, particularly when retinal findings are present.
Subject Abducens Nerve Diseases / diagnosis; Abducens Nerve Diseases / drug therapy; Acute Disease; Adult; Antineoplastic Agents / therapeutic use; Blood Cell Count; Bone Marrow / pathology; Contrast Media / administration & dosage; Flow Cytometry; Gadolinium / administration & dosage; Humans; Injections, Spinal; Magnetic Resonance Imaging; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma / diagnosis; Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy; Retinal Hemorrhage / diagnosis; Retinal Hemorrhage / drug therapy
OCR Text Show
Date 2021-03
Language eng
Format application/pdf
Type Text
Publication Type Journal Article
Source Journal of Neuro-Ophthalmology, March 2021, Volume 41, Issue 1
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/s6vz3xz2
Setname ehsl_novel_jno
ID 1765113
Reference URL https://collections.lib.utah.edu/ark:/87278/s6vz3xz2
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