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  1. Muhamad-Amin, R., Nur Hasnida Gani, Liza-Sharmini, A.T., Zamli, A.H.
    MyJurnal
    Acute lymphoblastic leukemia (ALL) is the most common
    childhood leukaemia. It is a malignant neoplasm caused by the proliferation of
    poorly differentiated precursors of the lymphoid cells. It is relatively
    uncommon in adult. In adult ALL, central nervous system (CNS) involvement
    is associated with poor prognosis. The incidence of CNS involvement has
    been reported between 7% and 15 %. We report a case of optic nerve
    infiltration in ALL in a 49 years old gentleman. He was diagnosed with
    precursor-B ALL. He was treated with chemotherapy and CNS prophylactic
    regime. He presented with sudden left eye loss of vision for one-day duration
    with history of right eye inferior visual field loss for the past three months. His
    visual acuity was no perception to light on the left eye and 6/9 on the right
    eye. There was marked left relative afferent pupillary defect. The right eye
    showed decreased in optic nerve function with inferior visual field defect.
    Anterior segment examination was unremarkable in both eyes. Left optic disc
    appeared normal but the right optic disc was pale. Blood investigation
    showed no sign of infection or haemoconcentration. Cerebral spinal fluids
    examination revealed abundant of white cells and blast cells. Magnetic
    resonant imaging showed bilateral optic nerve enhancement suggesting of
    bilateral optic nerves infiltration. He was started on a new regime of
    chemotherapy followed by cranial radiotherapy. Unfortunately, he succumbed
    to death due to septicaemia. There are variations in clinical presentation of
    optic nerve infiltration in leukaemic patients. Normal appearance of optic disc
    may not exclude the possibility of infiltration by malignancy. Assessment of
    the optic nerve function and imaging is helpful for the detection of leukaemic
    infiltration. Early detection of optic nerve infiltration is important for initiation or
    change of therapy to prevent mortality.
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