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Published on: March 26, 2018
Acute Sixth Nerve Palsy and Retinal Hemorrhages as the Presenting Features of Acute Lymphoblastic Leukemia
Malek A Alrobaian1, Maria Adelita Vizcaino, Amanda D Henderson
1Division 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.
