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03 July 2014 : Case report  Italy

Strabismus and Diplopia in a Patient with Acute Myeloid Leukemia

Unusual clinical course, Challenging differential diagnosis, Educational Purpose (only if useful for a systematic review or synthesis)

Claudio FozzaABEF, Fausto DoreBE, Maria Antonia IsoniBE, Francesco LonguBE, Laura DessìBE, Lorenzo CoppolaBE, Salvatore ContiniBE, Maurizio LonginottiABEF

DOI: 10.12659/AJCR.890526

Am J Case Rep 2014; 15:288-290

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.

Keywords: Cranial Nerve Diseases, Diplopia, Leukemia, Myeloid, Acute - cerebrospinal fluid

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923