Bilateral Facial Nerve Palsy in Acute B Cell Lymphoblastic Leukemia: A Case Report and Review of the Literature

Abstract

Acute lymphoblastic leukemia (ALL) is a haematological malignancy that can involve the central nervous system (CNS). Less than 10 % of patients with ALL have CNS involvement at presentation. The cranial nerve most commonly affected is cranial nerve VII although bilateral involvement is rare. Management and outcomes of these patients are not well understood. Moreover bilateral Bells palsy as a presenting symptom of ALL is extremely uncommon. We report a very unusual presentation of ALL with bilateral facial nerve palsy, and discuss the management strategies and outcomes for patients with ALL that present with cranial nerve palsies.

Keywords: Acute lymphoblastic leukemia; Bells palsy; CNS leukemia; Whole brain irradiation.

Fig. 1

Lymphoblasts containing scant cytoplasm, round to indented nuclei, homogenous chromatin, and occasional small nucleoli are seen involving the a peripheral blood, b bone marrow, and c cerebrospinal fluid. The bone marrow core biopsy is approximately 90 % cellular composed predominantly of lymphoblasts d Smears and cytospin are shown at ×1000 magnification, core biopsy at ×500