Diffuse cranial nerve infiltration in acute lymphoblastic leukemia: MRI diagnosis

Q4 Medicine
Meqor Ali M.D , Moudafia Zineb M.D , Chetoui Ayoub M.D , El kidari Jalal M.D , Alouazen Oula M.D , Choukri El Mahdi M.D , Oulad Amar Asmae M.D , Alaoui Rachidi Siham M.D
{"title":"Diffuse cranial nerve infiltration in acute lymphoblastic leukemia: MRI diagnosis","authors":"Meqor Ali M.D ,&nbsp;Moudafia Zineb M.D ,&nbsp;Chetoui Ayoub M.D ,&nbsp;El kidari Jalal M.D ,&nbsp;Alouazen Oula M.D ,&nbsp;Choukri El Mahdi M.D ,&nbsp;Oulad Amar Asmae M.D ,&nbsp;Alaoui Rachidi Siham M.D","doi":"10.1016/j.radcr.2025.09.019","DOIUrl":null,"url":null,"abstract":"<div><div>Cranial nerve involvement in acute lymphoblastic leukemia (ALL) is a rare manifestation of central nervous system infiltration and may present diagnostic challenges, particularly when cerebrospinal fluid (CSF) cytology is negative. We report the case of a 21-year-old male with known acute T-lymphoblastic leukemia undergoing chemotherapy, who presented with acute bilateral facial weakness consistent with seventh cranial nerve palsy and dysphagia suggestive of glossopharyngeal nerve involvement. Initial laboratory studies were unremarkable. Brain MRI revealed diffuse thickening and intense enhancement of multiple cranial nerves, including the facial and glossopharyngeal nerves, consistent with leukemic infiltration. CSF cytologic analysis did not demonstrate malignant cells, but further immunophenotypic assessment (flow cytometry) was not available. Given the clinical and radiologic findings, intrathecal chemotherapy was initiated, resulting in progressive improvement of neurologic symptoms. This case illustrates the critical role of MRI in diagnosing leukemic cranial nerve infiltration, particularly when CSF analysis is inconclusive. Early recognition is essential to guide prompt treatment and improve neurologic outcomes.</div></div>","PeriodicalId":53472,"journal":{"name":"Radiology Case Reports","volume":"20 12","pages":"Pages 6196-6202"},"PeriodicalIF":0.0000,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Radiology Case Reports","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1930043325008532","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0

Abstract

Cranial nerve involvement in acute lymphoblastic leukemia (ALL) is a rare manifestation of central nervous system infiltration and may present diagnostic challenges, particularly when cerebrospinal fluid (CSF) cytology is negative. We report the case of a 21-year-old male with known acute T-lymphoblastic leukemia undergoing chemotherapy, who presented with acute bilateral facial weakness consistent with seventh cranial nerve palsy and dysphagia suggestive of glossopharyngeal nerve involvement. Initial laboratory studies were unremarkable. Brain MRI revealed diffuse thickening and intense enhancement of multiple cranial nerves, including the facial and glossopharyngeal nerves, consistent with leukemic infiltration. CSF cytologic analysis did not demonstrate malignant cells, but further immunophenotypic assessment (flow cytometry) was not available. Given the clinical and radiologic findings, intrathecal chemotherapy was initiated, resulting in progressive improvement of neurologic symptoms. This case illustrates the critical role of MRI in diagnosing leukemic cranial nerve infiltration, particularly when CSF analysis is inconclusive. Early recognition is essential to guide prompt treatment and improve neurologic outcomes.
急性淋巴细胞白血病弥漫性脑神经浸润的MRI诊断
急性淋巴细胞白血病(ALL)脑神经受累是中枢神经系统浸润的一种罕见表现,可能会给诊断带来挑战,特别是当脑脊液(CSF)细胞学检查呈阴性时。我们报告一例21岁男性急性t淋巴细胞白血病患者接受化疗,其表现为急性双侧面部无力,符合第七脑神经麻痹和吞咽困难,提示舌咽神经受累。最初的实验室研究结果并不显著。脑MRI示多颅神经弥漫性增厚及强烈强化,包括面神经和舌咽神经,与白血病浸润一致。脑脊液细胞学分析未发现恶性细胞,但进一步的免疫表型评估(流式细胞术)不可用。鉴于临床和影像学表现,开始鞘内化疗,导致神经系统症状进行性改善。本病例说明了MRI在诊断白血病脑神经浸润中的关键作用,特别是当脑脊液分析不确定时。早期识别对于指导及时治疗和改善神经系统预后至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Radiology Case Reports
Radiology Case Reports Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
1.10
自引率
0.00%
发文量
1074
审稿时长
30 days
期刊介绍: The content of this journal is exclusively case reports that feature diagnostic imaging. Categories in which case reports can be placed include the musculoskeletal system, spine, central nervous system, head and neck, cardiovascular, chest, gastrointestinal, genitourinary, multisystem, pediatric, emergency, women''s imaging, oncologic, normal variants, medical devices, foreign bodies, interventional radiology, nuclear medicine, molecular imaging, ultrasonography, imaging artifacts, forensic, anthropological, and medical-legal. Articles must be well-documented and include a review of the appropriate literature.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信