Mbekeani Joyce N, Abdel Fattah Maaly, Al Nounou Randa M, Chebbo Wahiba, Dogar Mohammed Asif
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.
J Neuroophthalmol. 2016 Mar;36(1):73-7. doi: 10.1097/WNO.0000000000000326.
Bilateral, simultaneous optic nerve sheath infiltration as a manifestation of leukemia relapse is very rare. A 45-year-old woman with chronic myelogenous leukemia was successfully treated to cytogenetic bone marrow remission 1 year previously and maintained on imatinib. She developed total bilateral blindness with marked, bilateral optic disc edema and evidence of bilateral optic nerve infiltration on magnetic resonance imaging. Cerebrospinal fluid cytology confirmed central nervous system (CNS) blast crisis. She recovered visual acuity of 20/20 in the right eye, and 20/25 in the left eye with salvage systemic and intrathecal chemotherapy before radiation therapy. Our report underscores the importance of timely and aggressive intervention of blast crisis of the CNS and the need for CNS penetrating induction and maintenance therapy.
双侧同时性视神经鞘浸润作为白血病复发的一种表现非常罕见。一名45岁的慢性粒细胞白血病女性患者1年前成功治疗至细胞遗传学骨髓缓解，并接受伊马替尼维持治疗。她出现双侧完全失明，伴有明显的双侧视盘水肿，磁共振成像显示双侧视神经浸润。脑脊液细胞学检查证实为中枢神经系统（CNS）原始细胞危象。在放疗前，通过挽救性全身和鞘内化疗，她右眼视力恢复到20/20，左眼视力恢复到20/25。我们的报告强调了及时、积极干预CNS原始细胞危象的重要性以及CNS穿透性诱导和维持治疗的必要性。
