Chronic Myelogenous Leukemia Presenting with Oculomotor Nerve Palsy: A Case Report and Review of Literatures

Amrit Adhikari BK, Dinesh Sangroula, Saad Rahmat, Marie Chevenon


Introduction: Chronic myelogenous leukemia (CML), the most common sub-type of leukemia, usually presents with anorexia, fatigue, weight loss, splenomegaly, infection, and bleeding diasthesis. Cranial nerve palsy is a rare occurrence with myelo-proliferative disorder. Though prior literatures reported cranial neuropathies with different myelo-proliferative disorders, commonly acute leukemias and lymphomas, this is the first case of CML presenting with oculomotor nerve palsy.

Presentation of case: We report a 55-year old African American male presented in emergency department with features of third cranial nerve palsy, including unilateral ptosis, diplopia, and downward-outward deviation of eyeball without involvement of pupil. Clinical suspicion of CML, based on preliminary routine laboratory investigation, was confirmed by bone marrow biopsy and genetic testing of marrow aspirate. Patient was treated with Imatinib and regularly followed up with complete blood count.

Conclusion: CML may present with lone cranial nerve palsy as the first clinical finding. Hence, we emphasize to consider leukemia as one of the possible differential diagnoses in suspected patients presenting with isolated oculomotor palsy, if no other cause is evident.


Chronic Myelogenous Leukemia; CML; Oculomotor Nerve; Palsy

Full Text:



Konopka JB, Watanabe SM, Witte ON. An alteration of the human c-abl protein in K562 leukemia cells unmasks associated tyrosine kinase activity. Cell. 1984, 37(3):1035-1042

O'Brien S, Berman E, Moore JO, Pinilla-Ibarz J, Radich JP, Shami PJ, Smith BD, Snyder DS, Sundar HM, Talpaz M, Wetzler M. NCCN Task Force report: tyrosine kinase inhibitor therapy selection in the management of patients with chronic myelogenous leukemia. J Natl Compr Cancer Netw. 2011, 9(suppl 2):S1-S25

Emole J, Talabi T, Pinilla-Ibarz J. Update on the management of Philadelphia chromosome positive chronic myelogenous leukemia: role of nilotinib. Biologics. 2016, 10:23-31

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015, 65(1):5-29

National Cancer Institute. Surveillance, Epidemiology, and End Results (SEER) Program Stat Fact Sheet: Chronic Myeloid Leukemia. Bethesda, MD, 2015. Available at:

Huang X, Cortes J, Kantarjian H. Estimations of the increasing prevalence and plateau prevalence of chronic myeloid leukemia in the era of tyrosine kinase inhibitor therapy. Cancer. 2012, 118(12):3123-3127

Park YM, Cho JH, Cho JY, Huh JS, Ahn JY. Non-Hodgkin's lymphoma of the sphenoid sinus presenting as isolated oculomotor nerve palsy. World J Surg Oncol. 2007, 5:86

Savage DG, Szydlo RM, Goldman JM. Clinical features at diagnosis in 430 patients with chronic myeloid leukaemia seen at a referral centre over a 16-year period. Br J Haematol. 1997, 96(1):111-116

Bojsen-møller M, Nielsen JL. CNS involvement in leukaemia. An autopsy study of 100 consecutive patients. Acta Pathol Microbiol Immunol Scand A. 1983, 91(4):209-216

Matsuda R, Hironaka Y, Kawai H, Park YS, Taoka T, Nakase H. Unilateral oculomotor nerve palsy as an initial presentation of bilateral chronic subdural haematoma: Case report. Neurol Med Chir. 2013, 53(9):616-619

Costagliola C, Rinaldi M, Cotticelli L, Sbordone S, Nastri G. Isolated optic nerve involvement in chronic myeloid leukemia. Leuk Res. 1992, 16(4), 411-413

Kiratli H, Balci KE, Himmetoğlu C, Uner A. Isolated extraocular muscle involvement as the ophthalmic manifestation of leukaemia. Clin Experiment Ophthalmol. 2009, 37(6):609-613

Bhatti MT, Schmalfuss IM, Eskin TA. Isolated cranial nerve III palsy as the presenting manifestation of HIV-related large B-cell lymphoma: clinical, radiological and postmortem observations: report of a case and review of the literature. Surv Ophthalmol. 2005, 50(6):598-606

Chen CS, Miller NR, Lane A, Eberhart C. Third cranial nerve palsy caused by intracranial extension of a sino-orbital natural killer T-cell lymphoma. J Neuroophthalmol. 2008, 28(1):31-35

Levy J, Kratz A, Lifshitz T. Burkitt's lymphoma presenting as oculomotor palsy in an hiv-positive patient. Eur J Ophthalmol. 2006, 16(1):186-189

Manabe Y, Kurokawa K, Kashihara K, Abe K. Isolated oculomotor nerve palsy in lymphoma. Neurol Res. 2000, 22(4):347-348

Metellus P, Fuentes S, Figarella-Branger D, Dufour H, Grisoli F. Sphenoid sinus lymphoma. Case report and review of the literature. Neurochirurgie. 2002, 48:522-526

Sato H, Hashimoto T, Yoneda S, Hirabayashi K, Oguchi K, Higuchi K. Lymphoma as a cause of isolated oculomotor nerve palsy. J Clin Neurosci. 2011, 18(9):1256-1258

Tsai CH, Lee EJ, Liu YS, Chen YC, Shih YH, Chuang MT. Isolated oculomotor nerve palsy caused by diffuse large B cell lymphoma. Acta Neurol Belg. 2013, 113(1):103-104

Bhatt VR, Naqi M, Bartaula R, Murukutla S, Misra S, Papalzai M, Paramanathan AC, Dai Q. T cell acute lymphoblastic leukaemia presenting with sudden onset right oculomotor nerve palsy with normal neuroradiography and cerebrospinal fluid studies. BMJ Case Rep. 2012, doi: 10.1136/bcr.01.2012.5685

Oz O, Akgün H, Battal B, Yücel M, Oztürk K, Karadurmuş N, Gökçil Z, Odabaşi Z. Acute lymphoblastic leukemia presenting with oculomotor nerve palsy. Acta Neurol Belg. 2011, 111(4):362-364

Tabata M, Yoshida M, Takahashi H, Toshima M, Takatoku M, Tsunoda J, Miura Y. Oculomotor Nerve Invasion of Acute Myelogenous Leukemia Demonstrated by Magnetic Resonance Imagin. Leuk Lymphoma. 1998, 30(3-4):411-414

Al-Mujaini AS, Al-Dhuhli HH, Dennison DJ. Acute unilateral third nerve palsy as an early manifestation of central nervous system relapse in a patient with acute myeloid leukemia. Saudi Med J. 2009, 30(7):961-963

Meireles J, Garrett MC, Abreu P. Isolated III cranial nerve palsy: a Hodgkin's lymphoma? BMJ Case Rep. 2014, doi: 10.1136/bcr-2014-203999

Erben Y, Gonzalez Hoffmann C, Steinmetz H, Ziemann C. (04/2008). Isolated neuritis of the oculomotor nerve in infectious mononucleosis. Nervenarzt. 2008, 79(4):462-464

Çelebisoy N, Bayam FE, Çağırgan S, Hekimgil M. Primary central nervous system leukemia presenting with an isolated oculomotor palsy. J Clin Neurosci. 2008, 15(10):1144-1145

Kraus TS, Twist CJ, Tan BT. Angioimmunoblastic T Cell Lymphoma: An Unusual Presentation of Posttransplant Lymphoproliferative Disorder in a Pediatric Patient. Acta Haematologica. 2014, 131(2):95-101

Greco D, Gambina F, Maggio F. Ophthalmoplegia in diabetes mellitus: a retrospective study. Acta Diabetol. 2009, 46(1):23-26

Watanabe K, Hagura R, Akanuma Y, Takasu T, Kajnuma H, Kuzuya N, Irie M. Characteristics of cranial nerve palsies in diabetic patients. Diabetes Res Clin Pract. 1990, 10(1):19-27


  • There are currently no refbacks.

AJCC-REP (ISSN 2572-5742)Copyright © 2012-2021. All rights reserved. Published by Ivy Union Publishing, 3204 Valley Rush Dr, Apex, North Carolina 27502, United States