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CASE REPORT
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Cranial polyneuropathy and polyradiculopathy with intractable vomiting due to a rare etiology


1 Department of Neurology, National Institute of Mental Health and Neurosciences, Indiaeurosciences, Bengaluru, Karnataka, India
2 Department of Neuropathology, National Institute of Mental Health and Neurosciences, Indiaeurosciences, Bengaluru, Karnataka, India

Correspondence Address:
Girish Baburao Kulkarni,
Department of Neurology, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajim.ajim_37_22

Multiaxial involvement in neurological cases poses a diagnostic challenge even to the astute clinician. We present the case of a young man with multiple cranial nerve palsies, brain stem involvement, and subacutely progressive polyradiculoneuropathy. In addition, he had unexplained intractable vomiting, lymphadenopathy, and splenomegaly. These atypical features prompted us to evaluate for a secondary or systemic cause of polyneuropathy. Evaluation with neuroimaging and bone marrow examination revealed the underlying cause to be pre-T-cell acute lymphoblastic leukemia (pre-T-ALL). While acute lymphoblastic leukemia (ALL) is known to cause central nervous system involvement, such extensive multiaxial involvement as the first presentation in an adult is extremely rare. In this report, we describe the diagnostic approach to such a case and review the literature.


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