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68-jähriger Patient mit Vorhofflattern/Vorhofflimmern, inadäquater Antikoagulation, subakuter Amaurosis, normaler BSG und Lymphadenopathie

A 68-year-old patient with atrial flutter/fibrillation, inadequate anticoagulation, subacute amaurosis, normal ESR, and lymphadenopathy

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Zusammenfassung

In der vorliegenden Kasuistik wird eine seltene Erstmanifestation einer chronisch lymphatischen Leukämie beschrieben. Diese präsentierte sich klinisch als beidseitige progrediente Sehverschlechterung, wobei sich ophthalmoskopisch das typische Bild einer anterioren ischämischen Optikusneuropathie (AION) zeigte. Die klinische Symptomatik wurde durch eine Infiltration des Sehnerven bei meningealer Aussaat der Leukämiezellen verursacht. Diagnostisch wegweisend war die Liquorpunktion mit Druckmessung, die eine Abgrenzung der AION zu Stauungspapille und Papillitis erlaubt. Durch die nach der Diagnosestellung durchgeführte intrathekale und systemische Polychemotherapie konnte der Patient seine ursprüngliche Sehkraft wiedererlangen.

Abstract

We present a rare manifestation of chronic lymphatic leukemia with progressive bilateral visual loss and the typical fundoscopic picture of anterior ischemic optic nerve neuropathy (AION). Clinical symptoms were due to meningeal metastases and tumor cell infiltration of the optic nerve. The diagnostic clue was provided by lumbar puncture with pressure measurement, which made it possible to differentiate AION from papillitis and papilledema. In this case the patient was able to regain his initial visual activity after intrathecal and systemic polychemotherapy.

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Authors and Affiliations

  1. Medizinische Poliklinik, Ludwig-Maximilians-Universität München, Pettenkoferstraße 8a, 80336, München, Deutschland

    T.N. Abahji, J. Scherwat, S. Schmieder & H.J. Anders

  2. Neurologische Klinik, Klinikum Großhadern, Ludwig-Maximilians-Universität München, München, Deutschland

    S. Kastenbauer

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  1. T.N. Abahji
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  2. S. Kastenbauer
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  3. J. Scherwat
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  4. S. Schmieder
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  5. H.J. Anders
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Correspondence to T.N. Abahji.

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Abahji, T., Kastenbauer, S., Scherwat, J. et al. 68-jähriger Patient mit Vorhofflattern/Vorhofflimmern, inadäquater Antikoagulation, subakuter Amaurosis, normaler BSG und Lymphadenopathie. Internist 49, 873–876 (2008). https://doi.org/10.1007/s00108-008-2121-0

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  • DOI: https://doi.org/10.1007/s00108-008-2121-0

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