Author(s)
Zoe Weston, MS, CCC-SLP
Edward P. Lin, MD-MBA
Glenn Todd Schneider, MD-MS
Affiliation(s)
University of Rochester Medical Center Departments of Speech Language Pathology, Imaging Sciences, and Otolaryngology
Abstract:
Background/Objectives: Chronic lymphocytic leukemia (CLL) is the most common leukemia in the United States. Most patients are asymptomatic at diagnosis or present with cervical lymphadenopathy. However, in roughly 1% of patients CLL may spread to the meninges and lead to symptoms of headache, mental status change, cranial neuropathies, and cerebellar signs. Only 50% of patients with leptomeningeal spread of disease will present with cranial neuropathies the most common being diplopia (17.6%), facial weakness (8.8%), hearing loss (5.6%) and dysarthria (4.8%).
Methods: We present a case of a patient presenting to our Laryngology clinic with new onset dysarthria, dysphonia, and dysphagia and findings of a right side palate paralysis, pharyngeal constrictor weakness, and vocal fold immobility secondary to leptomeningeal recurrence of CLL. In addition, we also review the literature on leptomeningeal CLL as well as other forms of carcinomatous meningitis leading to cranial neuropathies affecting the voice and swallow function.
Results: Meningeal spread of CLL was diagnosed on MRI due to dural enhancement and confirmed with lumbar puncture. His symptoms and exam findings significantly improved with treatment of the CLL and a follow up MRI demonstrated resolution of the dural enhancement.
Conclusions: While leptomeningeal CLL causing cranial neuropathies is a rare occurrence, Otolaryngologists may be the ones diagnosing and managing these deficits. Meningeal spread of malignant disease should be part of our differential diagnosis when treating "idiopathic" cranial neuropathies as it can be a reversible cause of these deficits.