Multiple Cranial Nerve Involvement as the Initial Manifestation of Primary Central Nervous System Lymphoma
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Abstract
Background: Primary central nervous system lymphoma (PCNSL) which mostly consists of B-cell lymphomas can be described as extranodal high-grade non-Hodgkin lymphoma that is limited to the central nervous system.
Case presentation: We report a case of a newly-diagnosed retroviral-positive patient who first presented with multiple cranial nerve palsy, started with left facial asymmetry for three weeks and subsequently developed symptoms involving multiple neurological foci and eye manifestations. Blood investigations revealed a markedly elevated level of lactate dehydrogenase (LDH) and cerebrospinal fluid analysis showed the presence of Oligoclonal bands. Magnetic Resonance Imaging (MRI) of the brain and orbit revealed multiple brain hyperintense T2 lesions, enlarged extraocular muscle and perineural enhancement of the optic nerve. Diagnosis of central nervous system (CNS) lymphoma was eventually confirmed by biopsy of globus pallidus that showed diffuse large B-cell lymphoma however no specific treatment was initiated due to patient succumbed to death post biopsy.
Conclusion: Diagnosing PCNSL presents a diagnostic challenge due to its diverse clinical manifestation. It requires a high level of suspicion in immunocompromised patients presented with non-specific neurological and ophthalmic symptoms. Ideally, brain biopsy should not be delayed to establish a final diagnosis and initiate treatment.
Conflict of interest: None to declare.
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