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. 2016 Apr 7:2:15035.
doi: 10.1038/scsandc.2015.35. eCollection 2016.

Acute myeloid leukemia presenting with complete paraplegia and bilateral total blindness due to central nervous system involvement

Kohta Asano  1 , Hidetaka Wakabayashi  1 , Naohisa Kikuchi  1 , Hironobu Sashika  1
Affiliations

Acute myeloid leukemia presenting with complete paraplegia and bilateral total blindness due to central nervous system involvement

Kohta Asano et al. Spinal Cord Ser Cases. .

Erratum in

Abstract

We report a case of central nervous system (CNS) involvement in a 29-year-old man with acute myeloid leukemia (AML). Although leukemic cell invasion of the CNS in patients with AML has been reported in ~3% cases, multiple invasions of the CNS are rare. A 29-year-old man presented with rapidly progressive flaccid paralysis of the lower extremities. Laboratory findings showed blast cells, accounting for 79% of his white blood cell count. Thoracic spine magnetic resonance imaging showed a T2-hyperintense intramedullary lesion at the T6 level. Peroxidase staining was positive in cells isolated from a paravertebral mass as well as the bone marrow aspirate. The patient was diagnosed as having AML, with CNS involvement. We performed an emergency laminectomy between T6 and T9 with tumor resection. Following chemotherapy, although the patient achieved complete remission, the paraplegia did not improve. The patient showed signs of involvement of the cranial nerves and bilateral total blindness because of the involvement of visual areas in the cortex; these were considered to be caused by another lesion. Furthermore, heterotopic ossification resulted in left hip contractures. Despite the patient achieving complete remission of AML and improvement in overall prognosis, the patient's physical function remained limited.

Keywords: Acute myeloid leukaemia; Neurophysiology; Visual system.

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Figures

Figure 1
Figure 1
(a, b) Axial and sagittal T2-weighted thoracic spine MRI shows a high-intensity region in the spinal cord at T6 and a paravertebral mass from T6 to T9 on emergency admission. (c, d) Axial and sagittal T2-weighted thoracic spine MRI shows a high-intensity region in the spinal cord at T4 and T6 after the third course of chemotherapy.
Figure 2
Figure 2
(a) The head CT scan demonstrates a high-density area in the pituitary body and low-density masses in both orbital cavities on the eighth postoperative day. (b, c, d) Head MRI and orbital contrast MRI show no abnormal findings.
Figure 3
Figure 3
The hip joint X-ray image demonstrates the hip joint heterotopic ossification.
See this image and copyright information in PMC

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