T-Lymphoblastic Leukemia/Lymphoma in the Left Cavernous Sinus

Abstract

A 49-year-old male patient presented with complaints of diplopia for 2 months. He had no past medical history of vascular disorders such as diabetes, hypertension, or hyperlipidemia. In addition, he also reported swelling sensation and flashing light in his left eye. The patient visited a local eye clinic and received focal laser treatment for retinal break in the right eye before coming to our clinic. At our clinic, he was found to have good visual acuity of 6/5 in both eyes. He could identify 15 plates in the right eye but 0 plate in the left eye with the Ishihara test. A prism cover test revealed right hypertropia of 2 prism diopters, which increased to 4 diopters on left gaze. He also demonstrated 2 prism diopters upon head tilt to either side. There were also 6 prism diopters of exotropia noted. Extraocular movements showed mild limitation of supraduction in both eyes. A Maddox double rod test was normal. Anterior segments and fundoscopic examinations were negative. Four days later, he visited clinic again with resolution of diplopia. Blood testing for complete cell count, antinuclear antibody, and anti-AchR antibody was negative. A thyroid function test revealed mild elevation of T3 (205, normal range 82–179). MRI of the brain showed nonspecific changes over white matter.