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Proptosis Secondary to Orbital Bone Remodeling From Intracranial Hypertension

Thomas A. Eldredge, MBBS1; Saul N. Rajak, PhD, FRCOphth1,2,3; Ajay Taranath, MBBS, MD, FRANZCR4; Dinesh Selva, MBBS, FRANZCO1,2,3
[+] Author Affiliations
1Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, Australia
2South Australian Institute of Ophthalmology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, Australia
3School of Ophthalmology and Visual Sciences, University of Adelaide, North Terrace, Adelaide, South Australia, Australia
4Department of Radiology, Women’s and Children’s Hospital, North Adelaide, South Australia, Australia
JAMA Ophthalmol. 2016;134(6):714-715. doi:10.1001/jamaophthalmol.2016.0929.
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Extract

This report describes a case of proptosis secondary to remodeling of the orbital bones in a patient with intracranial hypertension from acute lymphoblastic leukemia.

Chronically elevated intracranial pressure (ICP) can cause bony remodeling of the cranial vault. This has been reported to occur in the sphenoid bone and the ethmoid and temporal bones, where nasal or otic cerebrospinal fluid (CSF), respectively, can leak.1 We report a case of proptosis secondary to remodeling of the orbital bones in a patient with intracranial hypertension (IH) from acute lymphoblastic leukemia.

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Figure 1.
Clinical Photograph

Clinical photograph exhibiting bilateral globe protrusion at first encounter (A) and again 12 months later (B).

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Figure 2.
Cranial Imaging Illustrating Progressive Changes Over 6-Year Period

A-C, Coronal computed tomographic scans (top row: soft-tissue windows; bottom row: bony windows) and T1-weighted magnetic resonance imaging scan (bottom rightmost image) display progressive scalloping of the floor of the orbital roofs (arrows) and lateral displacement of the medial orbital walls (brackets).

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