Background: Meningeal syndrome during the course of acute lymphoblastic leukaemia (ALL), especially in children, is well recognized. Multiple cranial nerve palsies as the initial presentation of aleukaemic ALL in adults is, however, rare.Case Report: A 27-year-old male patient presented with multiple cranial nerve palsies. There was no lymphadenopathy or hepatosplenomegaly. Peripheral blood smear didnot reveal any blasts. There were atypical lymphoid cells in the cerebrospinal fluid. Bone marrow aspiration done subsequently revealed aleukaemic ALL.Conclusions: The case is reported for the rarity of cranial nerve palsies including ninth and tenth nerve palsies in adult aleukaemic ALL.

Keywords: Cranial nerve palsies, aleukaemic leukaemia, acute lymphoblastic leukaemia, bulbar palsy