Lymphomatous meningitis (LM) is a complication of systemic non-Hodgkin lymphomas.
Clinical features include confusion, seizures, headaches, and cranial nerve (CN) palsies.
The facial nerve is the CN usually affected; however, bilateral palsy is considered
rare in LM. We present the case of a 62-year-old man who showed lower extremity weakness
and bilateral facial paralysis chiefly involving the upper lip, with inability to
smile and whistle. His medical history was significant for stage IV diffuse large
B-cell lymphoma which had been treated with chemotherapy some months ago. Head computed
tomography was negative for acute intracranial process. A brain magnetic resonance
imaging showed bilateral enhancement of the facial nerve across the internal auditory
meatus. A lumbar puncture displayed lymphomatous cells consistent with LM. An Ommaya
reservoir was placed, and he completed intrathecal methotrexate infusions. He next
underwent autologous stem cell transplant and reports continuous improvement in weakness
of limbs and resolution of the facial palsy. Bilateral facial palsy was the initial
sign of LM in this patient with non-Hodgkin lymphoma and is a warning that must trigger
detailed investigation including central nervous system imaging and lumbar puncture,
to establish a prompt treatment.
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Article Info
Publication History
Published online: June 07, 2016
Accepted:
June 3,
2016
Received:
May 23,
2016
Footnotes
☆This case report emphasizes the importance of an uncommon pathologic condition and discusses different etiologies.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
