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A 56-year-old man with acute vision loss
Digital Journal of Ophthalmology 2016
Volume 22, Number 3
August 18, 2016
DOI: 10.5693/djo.03.2015.05.006
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Fani Akritidou | General Hospital of Kavala
Maria Karafyloglou | General Hospital of Kavala
Dimitrios Karamanis | General Hospital of Kavala
Ancillary Testing
Blood analysis including full blood count, basic biochemical analysis, C-reactive protein, and blood coagulation examinations were normal; serum antibodies (rheumatoid factor, antinuclear antibodies, anti-neutrophil cytoplasmic antibodies) were negative. All radiological and echographical controls were normal. Magnetic resonance imaging (MRI) and computed tomography (CT) of the brain and orbits revealed no abnormalities.

After the patient complained of neurological symptoms (severe headache with nausea, and epileptic seizures), lumbar puncture was performed. Cerebrospinal fluid (CSF) was colorless and slightly cloudy/turbid. CSF glucose was 70 mg/dl, and CSF protein level was 80.5 mg/dl. CSF total cell number was 180 per cubic millimeter, with lymphatic cells at 10% and dysplastic/atypical cells at 90%. CSF cytology revealed the presence of a few white cells, a few round shaped epitheliod cells with eccentric nuclei, and some atypical multinucleated cells. The examination was positive for malignant cells, and the presence of dysplastic/atypical cells confirmed the diagnosis of meningeal carcinomatosis.