POC11 Multiple radiculopathies and cranial nerve palsies in association with chronic lymphocytic leukaemia and lupus anti-coagulant treated with rituximab

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BlankJ Neurol Neurosurg Psychiatry 2010;81:e37 doi:10.1136/jnnp.2010.226340.81

POC11 Multiple radiculopathies and cranial nerve palsies in association with

chronic lymphocytic leukaemia and lupus anti-coagulant treated with rituximab

1.. J Morrow,

2.. R Page,

3.. M Al Hilali,

4.. S D'Sa,

5.. M M Reilly

+ Author Affiliations

1.. UCL Institute of Neurology, Queen Square, London, UK

1.. Correspondence to j.morrow@...

Abstract

A 53 year old woman with a 3-year history of progressive weakness and numbness

of all four limbs and multiple cranial nerve palsies is presented. She had been

diagnosed with chronic lymphocytic leukaemia (CLL), Rai stage 0, 1 year into her

neurological illness. Laboratory investigations showed a positive lupus

anticoagulant in addition to mild lymphocytosis. Magnetic resonance imaging of

the entire neuroaxis with gadolinium and cerebrospinal fluid analysis were

normal. Nerve conduction studies were normal. Electromyography showed changes of

chronic denervation in face and limb muscles suggestive of multiple

radiculopathies. Her neurological syndrome had previously failed to respond to

anticoagulation, oral fludarabine or corticosteroid treatment. The clinical

diagnosis was of CLL-associated immune mediated preganglionic neuropathy. She

was treated with rituximab and had a dramatic response with return to normal

strength 2 months after completing treatment. The associations between CLL,

neuropathy and antiphospholipid antibodies are reviewed.