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Título

NEUROLOGICAL COMPLICATIONS IN LYMPHOHEMATOPOIETIC LINEAGE NEOPLASMS: REPORTS ON CRANIAL NERVE INFILTRATION AND ITS DIAGNOSTIC CHALLENGE

RESUMO

CASE PRESENTATION: CASE 1: LPS, male, 46y. Presented with pain in the lumbar region for 6 months with irradiation to the left lower limb and bilateral inguinal lymphadenopathy. Laboratorial investigation showed leukocytosis with left shift. Immunophenotyping (IPT) suggestive of chronic myeloproliferative disease. During hospitalization, developed Peripheral Facial Palsy (PFP), being managed as Bell’s Palsy (BP) while CNS infiltration was investigated. CASE 2: ACDS, male, 70y. Presented with melena, enterorrhagia, hepatomegaly and mobile painless lymphadenopathy. IPT suggestive of chronic lymphoproliferative B cells disease. During hospitalization, evolved with ptosis of the right eyelid, hypotropia and esophoria. DISCUSSION: We report the investigation of two patients diagnosed with neoplasm of the lymphohematopoietic lineage that developed cranial nerve (CN) palsy. Case 1 reports a patient with chronic myeloid leukemia that develops PFP, a rare finding. Thus, BP was raised as a possible diagnosis. Contrast-enhanced MRI of the brain showed thickening of the 7th CN suggestive of leptomeningeal metastasis, a finding also seen in BP. Patient was transferred without being able to perform specific LCR analysis. Case 2 presents a patient with lymphoma that develops an incomplete 3rd CN palsy. Contrast-enhanced MRI of the brain showed no significant changes. CSF analysis did not present with neoplastic cells, despite hypoglycorrhachia and increased protein. Reports suggest that such findings do not rule out the cranial nerve involvement. FINAL COMMENTS: Neurological involvement can occur during the natural history of hematological neoplasms, especially in leukemia and lymphoma. Despite several clinical presentations, cranial nerve impairment is the most common and more easily noticeable of the extra-hematological manifestations. Even so, its diagnosis is not simple, as diagnostic confirmation requires invasive and difficult-to-access complementary investigations, which makes the confirmation a challenge. Therefore, even though CN infiltration by hematological neoplasms is rare, if a CN impairment appears in a patient with positive neoplastic history, it is worth investigating. The investigation should include imaging and cerebrospinal fluid study. Sometimes the diagnosis is presumptive and it is plausible to believe that the challenge of confirming the diagnosis is the probable cause of its low epidemiology.

Palavras Chave

Lymphohematopoietic, Complications, Cranial Nerve, Infiltration

Área

Neuroimunologia