Abstract
DISORDERS that simultaneously involve several organ systems can produce confusing clinical pictures, and the combination of oronasal bleeding, visual impairment, and altered sensorium is particularly striking in this regard. Nevertheless, this is the picture that can be produced by an increased serum viscosity.1,2The bleeding characteristically occurs from the nose, mouth, or gums but may stem from the gastrointestinal or genitourinary tract. Postoperative oozing is also common. Ocular symptoms range from partial to complete loss of vision due to retinal hemorrhages, venous changes, or even papilledema. The neurologic disturbances, often known as the Bing-Neel syndrome, include headache, dizziness, true vertigo, deafness, nystagmus, diplopia, ataxia, paresthesias, and postural hypotension. Less often, congestive heart failure or renal impairment is seen. The main cause of the hyperviscosity syndrome is increased viscosity of the serum (as in macroglobulinemia or myeloma), although increased numbers of cells (polycythemia or leukemia) or increased resistance of cells
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