Facial nerve palsy in acute leukaemia

During a three year period, of 62 children and adults seen with lymphoblastic leukaemia 6 developed unilateral facial paralysis during the course of their disease, compared to none of 54 adults and children with acute non-lymphatic leukaemia seen during the same period. In all cases the problem arose in patients with refractory disease and was associated with the development of resistant bone marrow infiltration. The neuropathy showed no obvious response to intrathecal therapy and whilst meningeal infiltration was present at some stage in all but one of the 6, this waxed and waned independently of the facial palsy. Four of the 6 cases described had stigmata of the T-cell variety of lymphoblastic leukaemia, which is a significantly higher proportion than would be expected by chance. This apparent association with T-cell disease has not been previously recognised.