Abstract

Abstract: Although chronic lymphocytic leukemia (CLL) is the most prevalent leukemia in the Western world, neurological complications directly involving the nervous system are exceedingly rare, reported in only 1% of CLL patients—ocular manifestations in CLL, whether direct or indirect, are even less documented and exceptionally uncommon. Here, we present the case of a 63-year-old female with CLL undergoing chemotherapy who developed novel neurological symptoms, including ocular flutter (horizontal saccadic intrusions), resting and intentional tremors in the right limbs, and intermittent jaw movements. With no established protocol for CLL with central nervous system involvement, documenting such cases becomes crucial for defining optimal diagnostic and therapeutic strategies early in the disease course.

Keywords: Chronic Lymphocytic Leukemia, Ocular Flutter, Intermittent Jaw Movements

Introduction: CLL is characterized by the proliferation of dysfunctional B-cell lymphocytes, which primarily affect blood, spleen, lymph nodes, and bone marrow. While ocular manifestations are recognized in leukemia, direct involvement of ocular tissue and neuro-ophthalmic changes remain infrequent, with ocular flutter being infrequent.

Case History: A 63-year-old female with CLL, treated with Rituximab and Bendamustine, presented with fever, altered sensorium, and neurological symptoms, including ocular flutter and intermittent jaw movements. Extensive diagnostic work-up ruled out infectious, autoimmune, and drug-induced etiologies. Despite aggressive management, including antiviral therapy and immunoglobulin trials, the patient deteriorated and succumbed to complications.

Discussion: This case highlights diagnostic challenges and underscores the need for heightened awareness of neurological manifestations in CLL. The rarity of ocular flutter in CLL suggests potential mechanisms involving direct leukemic infiltration or immune-mediated processes, necessitating further investigation.

Conclusion: Given the lack of literature on ocular flutter in CLL, this case emphasizes the importance of systematic data collection to inform effective management strategies. Enhancing clinician awareness of atypical neurological presentations in CLL is crucial for timely intervention and improved outcomes.