Case report: Bilateral facial palsy in pediatric acute lymphoblastic leukemia with central nervous system relapse.

Abstract

Objective: To report the youngest case of a bilateral facial palsy secondary to a central nervous system relapse from acute lymphoblastic leukemia in a female young patient that was treated with intrathecal chemotherapy, systemic corticosteroids, and physical therapy with successful outcomes. Design: A case report of a 9-years old female patient with bilateral facial palsy. Results: A 9-years old patient with acute lymphoblastic leukemia presented with a complete right facial nerve palsy that progresses 10 days later to a simultaneous grade IV House-Brackmann left facial nerve palsy. Neuroimaging showed basal pachymeningeal and bilateral facial nerve enhancement, predominantly in the right side. Central nervous system metastasis was confirmed with cerebrospinal fluid cytometry and medical therapy was initiated with intrathecal chemotherapy, systemic corticosteroids, and physical therapy. Three weeks after the onset of treatment, both facial palsies ameliorated to a grade IV and III, left and right facial palsy, respectively. Conclusion: Central nervous system metastasis must be considered as a differential diagnosis of simultaneous bilateral facial palsy is presented. Early treatment with intrathecal chemotherapy, systemic corticosteroids and physical therapy may improve patients' outcomes.