Posters
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Medical Student
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Internal Medicine
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Internal Medicine
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Neurology
Presentation Type
Poster
Discipline Track
Clinical Science
Abstract Type
Research/Clinical
Abstract
Background: Acute lymphoblastic leukemia (ALL) accounts for 20% of adult leukemias, with outcomes improving through modern systemic and CNS-directed therapies. Leukemic meningeal relapse, defined as infiltration of the meninges and detected by cerebrospinal fluid cytology, is reported in 4–7% of adult ALL patients and remains a devastating complication despite CNS prophylaxis. CNS involvement typically presents with nonspecific symptoms such as headache, nausea, or cranial neuropathies; isolated, abrupt vision loss is rare. With a median survival of less than six months if untreated, timely recognition is critical. We present a case of intracranial hypertension with bilateral vision loss due to leukemic meningeal relapse following chemotherapy cessation during pregnancy.
Case: A 23-year-old woman with no prior medical history was diagnosed with ALL in 2023 and initiated systemic chemotherapy, which was discontinued in July 2024 due to pregnancy. She delivered via cesarean section in June 2025.
Beginning in April 2025, she developed progressive headaches, neck pain, bilateral hand paresthesias, and visual disturbances that progressed to complete left eye blindness in April and acute right eye blindness two days before admission in July 2025. On presentation, she reported headaches, retro-orbital pain, neck stiffness, left-hand numbness, and bilateral blindness. Neurologic examination revealed complete bilateral vision loss, a positive Brudzinski sign, decreased sensation in the left 1–3 digits, brisk reflexes, and bilateral papilledema on fundoscopy. Laboratory studies showed leukocytosis with neutrophilia.
CT orbits demonstrated diffuse edema of the left optic nerve and disc with non-visualization of the left ophthalmic artery and its branches. CT head revealed no hemorrhage or mass effect, while CTA excluded vascular stenosis or aneurysm. MRI scans of the orbits showed optic nerve sheath enhancement. Bone marrow biopsy revealed residual B-lymphoblastic leukemia/lymphoma (B-ALL/LBL). Lumbar puncture revealed an elevated opening pressure of 32 cm H₂O with lymphocytic pleocytosis (595 cells), consistent with leukemic meningeal relapse.
Differential diagnosis included optic neuritis, idiopathic perineuritis, and optic nerve sheath meningioma. However, the combination of prior ALL, abrupt bilateral vision loss, CSF findings, and residual marrow disease strongly supported leukemic meningeal relapse as the primary etiology.
The patient was started on dexamethasone and mannitol for intracranial pressure control. Additionally, neurosurgery placed an Ommaya reservoir for CSF diversion and intrathecal methotrexate administration. The patient was transferred to another hospital for a higher level of care.
Conclusion: This case illustrates a rare presentation of leukemic meningeal relapse, manifesting as progressive bilateral blindness in a young woman whose chemotherapy had been interrupted during pregnancy. Adult cases of bilateral optic nerve infiltration as the first sign of relapse are scarce and may indicate an aggressive or overlooked CNS relapse. This underscores the importance of vigilance for neurological or visual symptoms in ALL patients, even outside active treatment. Prompt diagnosis through imaging and CSF analysis, followed by intrathecal chemotherapy and supportive interventions, is essential to preserve neurologic function and extend survival in this fatal condition; however, prognosis for vision recovery remains poor. This case highlights the need for uninterrupted leukemia therapy, close monitoring during pregnancy, and early recognition of CNS relapse.
Recommended Citation
Bangash, Aun A.; Swamy, Tejaswini; Harris, Chloe C.; and Parada, Victoria, "Blinded by Relapse: A Rare Case of Bilateral Vision Loss from Leukemic Meningeal Infiltration" (2026). Research Symposium. 1.
https://scholarworks.utrgv.edu/somrs/2026/posters/1
Included in
Blinded by Relapse: A Rare Case of Bilateral Vision Loss from Leukemic Meningeal Infiltration
Background: Acute lymphoblastic leukemia (ALL) accounts for 20% of adult leukemias, with outcomes improving through modern systemic and CNS-directed therapies. Leukemic meningeal relapse, defined as infiltration of the meninges and detected by cerebrospinal fluid cytology, is reported in 4–7% of adult ALL patients and remains a devastating complication despite CNS prophylaxis. CNS involvement typically presents with nonspecific symptoms such as headache, nausea, or cranial neuropathies; isolated, abrupt vision loss is rare. With a median survival of less than six months if untreated, timely recognition is critical. We present a case of intracranial hypertension with bilateral vision loss due to leukemic meningeal relapse following chemotherapy cessation during pregnancy.
Case: A 23-year-old woman with no prior medical history was diagnosed with ALL in 2023 and initiated systemic chemotherapy, which was discontinued in July 2024 due to pregnancy. She delivered via cesarean section in June 2025.
Beginning in April 2025, she developed progressive headaches, neck pain, bilateral hand paresthesias, and visual disturbances that progressed to complete left eye blindness in April and acute right eye blindness two days before admission in July 2025. On presentation, she reported headaches, retro-orbital pain, neck stiffness, left-hand numbness, and bilateral blindness. Neurologic examination revealed complete bilateral vision loss, a positive Brudzinski sign, decreased sensation in the left 1–3 digits, brisk reflexes, and bilateral papilledema on fundoscopy. Laboratory studies showed leukocytosis with neutrophilia.
CT orbits demonstrated diffuse edema of the left optic nerve and disc with non-visualization of the left ophthalmic artery and its branches. CT head revealed no hemorrhage or mass effect, while CTA excluded vascular stenosis or aneurysm. MRI scans of the orbits showed optic nerve sheath enhancement. Bone marrow biopsy revealed residual B-lymphoblastic leukemia/lymphoma (B-ALL/LBL). Lumbar puncture revealed an elevated opening pressure of 32 cm H₂O with lymphocytic pleocytosis (595 cells), consistent with leukemic meningeal relapse.
Differential diagnosis included optic neuritis, idiopathic perineuritis, and optic nerve sheath meningioma. However, the combination of prior ALL, abrupt bilateral vision loss, CSF findings, and residual marrow disease strongly supported leukemic meningeal relapse as the primary etiology.
The patient was started on dexamethasone and mannitol for intracranial pressure control. Additionally, neurosurgery placed an Ommaya reservoir for CSF diversion and intrathecal methotrexate administration. The patient was transferred to another hospital for a higher level of care.
Conclusion: This case illustrates a rare presentation of leukemic meningeal relapse, manifesting as progressive bilateral blindness in a young woman whose chemotherapy had been interrupted during pregnancy. Adult cases of bilateral optic nerve infiltration as the first sign of relapse are scarce and may indicate an aggressive or overlooked CNS relapse. This underscores the importance of vigilance for neurological or visual symptoms in ALL patients, even outside active treatment. Prompt diagnosis through imaging and CSF analysis, followed by intrathecal chemotherapy and supportive interventions, is essential to preserve neurologic function and extend survival in this fatal condition; however, prognosis for vision recovery remains poor. This case highlights the need for uninterrupted leukemia therapy, close monitoring during pregnancy, and early recognition of CNS relapse.
