Blindness due to leptomeningeal carcinomatosis as an initial manifestation of recurrent acute lymphoblastic leukemia

Acute Bilateral Vision Loss Following Unilateral Optic Nerve Sheath Fenestration

Optic nerve sheath fenestration (ONSF) is a surgical technique commonly and effectively employed in the treatment of recalcitrant, vision-threatening papilledema. Unilateral blindness, a known risk of unilateral ONSF widely cited with 1%-2% incidence. In this case, a 58-year-old patient who presented symptomatic with bilateral hemorrhagic papilledema unresponsive to medical therapy underwent uneventful unilateral ONSF via standard superomedial eyelid crease incision. The patient presented postoperatively with severe bilateral vision loss. Workup revealed widespread metastatic malignant disease involving the optic chiasm and optic nerve sheath.

Leptomeningeal Carcinomatosis with Delayed Ocular Manifestations

The most common presenting symptoms of leptomeningeal carcinomatosis (LC) are ocular manifestations with vision loss. There are multiple reports of undiagnosed LC causing sudden, complete, monocular vision loss as the presenting symptom; however, sudden bilateral vision loss 6 months following diagnosis has not been described. Any new ocular involvement or worsening of previous ocular symptoms warrants reimaging and prompt ophthalmology consultation, as this likely indicates disease progression. This report details a unique case of LC where a previously diagnosed patient developed sudden, complete, bilateral vision loss and multiple cranial nerve palsies with progression of LC on imaging.