Murat TERZİ, Nilgün CENGİZ, Lütfi İNCESU, Murat K. ONAR

T-cell akut lenfoblastik lösemide multipl kranial sinir tutulumu

Amaç: Kranial sinir paralizisiyle prezente olan lenfoproliferatif hastalık olgusu sık değildir. En sık 7. kranial sinir tutulumu olup, onu 3. ve 6. kranial sinir izler. Biz iki taraflı fasial paralizi, sol trigeminal sinir tutulumu, sağ gözde progresif görme azlığı ve ışık refleksinin alınamadığı, sol abdusens sinir tutulumunun olduğu T-cell ALL’li bir olgu sunuyoruz. Olgu sunumu: Yirmi altı yaşındaki T-cell ALL tanısı almış erkek hasta diplopi, sağ gözde görme azlığı şikayetiyle getirildi. Nörolojik muayenesinde, bilateral periferik fasial paralizi, sol nervus abdusens paralizisi, sağ gözde direkt ışık refleksi kaybı ve sol trigeminal sinir innervasyon alanında hipoestezi vardı. Beyin kontrastlı MRG incelemesinde optik, okulomotor, trigeminal sinirler ve internal akustik kanallarda bilateral, abdusens sinirde ise unilateral diffüz homojen gadolinyum tutulumu gözlendi. Sonuç: Lösemiler direkt olarak sinir sistemi invazyonu yaparak veya indirekt olarak hematolojik faktörlerde değişikliklere neden olarak nörolojik disfonksiyonlara yol açabilirler. ALL olgularında SSS tutulumunda immünofenotip önemli rol oynamaktadır. Özellikle T-cell ALL, B-cell lösemi ve Burkitt lenfomada SSS tutulum riski artmaktadır.

Multiple cranial nerve involvement in T-cell acute lymphoblastic leukemia

Objective: Lymphoproliferative disorders presented as cranial nerve palsy is not common. Cranial nerve VII most frequently involved followed by cranial nerves III and VI. We describe a case with T-cell ALL with bilateral peripheral type facial palsy, left trigeminal nerve involvement, progressive vision loss and no light perception in the right eye and left abducens nerve palsy. Case report: A 26-year-old male was diagnosed as T-cell ALL. The patient was admitted with an acute onset of diplopia and vision loss in the right eye. Neurological examination revealed left sixth nerve palsy, bilateral complete facial paralysis, no light perception in the right eye and parasthesia of the left trigeminal nerve. Brain MRI showed diffuse hemogenous gadolinium contrast enhancement to the bilateral oculomotor nerve, trigeminal nerve, optic nerve, internal acustic canals and left abducens nerve. Conclusion: The leukemias may cause neurologic dysfunction through either direct invasion of the nervous system or indirectly through altered hematologic factors. Increased incidences of CNS leukemia occur in ALL with certain immunophenotypes, specifically T-cell ALL, B-cell leukemia and Burkitt’s lymphoma

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