title: Strabismus and diplopia in a patient with acute myeloid leukemia.
abstract: METHODS
  Male, 64 FINAL DIAGNOSIS: Acute myeloid leukemia (AML) Symptoms: -
  
  
  METHODS
  - Clinical Procedure: - Specialty: -
  
  
  OBJECTIVE
  Unusual clinical course.
  
  
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Fozza
authors.affiliation: Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Dore
authors.affiliation: Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
authors.forename: Maria Antonia
authors.initials: MA
authors.lastname: Isoni
authors.affiliation: Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Longu
authors.affiliation: Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Dessì
authors.affiliation: Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Coppola
authors.affiliation: Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Contini
authors.affiliation: Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Longinotti
keywords: Acute – cerebrospinal fluid; Cranial Nerve Diseases; Diplopia; Leukemia; Myeloid