Unilateral facial nerve palsy as an early presenting symptom of relapse in a paediatric patient with acute lymphoblastic leukaemia

Description

Idiopathic unilateral facial nerve paralysis (Bell palsy) rarely occurs as a presenting symptom of childhood leukaemia, and published reports of Bell palsy as a symptom of leukaemic relapse are even fewer.1–3 These images show the MRI findings in this case of peripheral facial nerve palsy as an early presenting symptom of central nervous system (CNS) relapse.

This patient was diagnosed at 12 years of age with T-cell acute lymphoblastic leukaemia without CNS involvement. Five months into therapy, he developed vision loss in the left eye secondary to optic nerve leukaemic infiltration. Radiation therapy and intensification of his chemotherapy induced a durable radiographic response.

Sixteen months into therapy, the patient presented with a 1-day history of unilateral facial weakness. An MRI of the brain showed mild enhancement of portions of the right facial nerve, consistent with Bell palsy (figure 1). The...

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