[Case Report] 58yo with acute myeloid leukaemia and diplopia

Pomegranate Health

This podcast follows the case of a 58 year old man who presented to the haematology department at Flinders Medical Centre with intravascular coagulation and leukocytosis. He was diagnosed with acute myeloid leukaemia and treated on standard cytarabine and daunorubicin combination therapy. Nine days after initiation, the patient developed painless diplopia and ptosis, and the story is picked up with a referral to the neurology department.

Guests
Associate Professor Stephen Bacchi (Lyell McEwin Hospital; University of Adelaide)
Dr James Triplett FRACP (Flinders Medical Centre, consultant neurologist)
Production
Produced by Stephen Bacchi and Mic Cavazzini. Music licenced from Epidemic Sound includes ‘Rockin’ for Decades’ by Blue Texas and ‘Brighton Breakdown’ by BDBs. Image created and copyrighted by RACP. Editorial feedback kindly provided by RACP physicians Aidan Tan and Brandon Stretton.

Please visit the Pomegranate Health web page for a transcript and supporting references. Login to MyCPD to record listening and reading as a prefilled learning activity.

Key Reference and Learning Points (Spoiler Alert)
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Painless progressive mononeuritis multiplex secondary to AML associated neuroleukemiosis [J Neuroimmunol. 2023]
(1) Chemotherapy can have neurological complications, including chemotherapy induced peripheral neuropathy (e.g., oxaliplatin).

(2) A third (oculomotor) cranial nerve palsy has multiple possible causes, which can be divided into painful vs painless causes, and compressive (classically with pupillary involvement) vs non-compressive (can spare pupil, as with microvascular insult) causes.

(3) Conduction block is shown by a significant reduction in compound muscle action potential, between proximal and distal stimulation, the criteria for which varies by nerve.

(4) Ascertaining whether conduction block occurs at compressible vs non-compressible sites can be a useful distinguishing feature for the various possible causes e.g. including compression, demyelination, and ischaemia, and

(5) Mononeuritis multiplex, while classically associated with a vasculitic neuropathy, has a number of causes, including leukaemia. This is the very rare condition known as neuroleukemiosis.