Volume 68 Number 6 November 2001	back to contents

Facial Diplegia as the Presenting Manifestation of Acute Lymphoblastic Leukemia	406-409
Ami Schattner, M.D., Natasha Kozack, M.D., Alexander Sandler, M.D. and Mordechai Shtalrid, M.D.
Departments of Medicine and Hematology, Kaplan Medical Center, Rehovot and the Hebrew University-Hadassah School of Medicine, Jerusalem, Israel. Address all correspondence to Ami Schattner, M.D., Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, 6th Floor, Boston, MA 02215.

ABSTRACT
A 36-year-old man with recent onset of unilateral peripheral 7th nerve paresis presented ten days later with involvement of the other side of his face. Physical examination was otherwise normal, and since blood tests and imaging were also normal, he was considered to have bilateral Bell's palsy. However, unexpected headaches and worsening of the paresis led to a gallium-67 scan which revealed uptake in the mediastinum. A repeat lumbar puncture revealed cells which were identified as lymphoblasts. T-cell acute lymphoblastic leukemia (T-ALL) was diagnosed, although the peripheral blood smear was normal. The differential diagnosis of bilateral 7th nerve palsy and of mononuclear cerebrospinal fluid pleocytosis is discussed, as well as this rare central nervous system presentation of acute leukemia.

KEY WORDS
Acute lymphoblastic leukemia, Bell's palsy, cerebrospinal fluid, cranial seventh nerve, facial diplegia.

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