Leukemic infiltration of the optic nerve
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Decreased visual acuity of left orbit during chemotherapy for acute lymphoblastic leukemia.
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MRI with and without GAD demonestrate diffuse thickening and high signal intensity with perineural enhancment of the left opic nerve and intraconal fat infiltration.
Thickening and enhancement of the optic nerve in patients with underlying leukemia should be considered suspicious for leukemic infiltration and should be differentiated from optic neuritis. The leukemic infiltration of the optic nerve is more common in children. The chemotherapeutic drugs cannot penetrate the blood-brain barrier and the invasion of leukemic cells in the small optic canal can interfere with the flow of CSF.