Cranial Polyneuropathy and Polyradiculopathy with Intractable Vomiting due to a Rare Etiology

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.