[Primary clivus diffuse large B cell lymphoma presenting with posterior neck pain and bilateral abducens nerve palsy]

Bilateral abducens nerve palsy is an unusual clinical presentation, which could be caused by stroke, aneurysm, trauma and malignant neoplasm. We describe here a patient with bilateral abducens nerve palsy caused by large B cell lymphoma originated from clivus. An 83-year-old woman admitted to our hospital because of diplopia and severe posterior neck pain. Her diplopia developed one month before and progressed to her admission. Neurological examination revealed bilateral abducens nerve palsy. Brain MRI with enhancement lesion in the clivus, suggesting that bilateral petroclival segment of the abducens nerves were affected by the lesion. Biopsied was performed via a transsphenoidal approach, and histological diagnosis was made as diffuse large B cell lymphoma. She received oral corticosteroid administration combined with radiation therapy. After initiation of the treatment, posterior neck pain was resolved and tumor size was reduced in the repeated brain MRI. However, diplopia and bilateral abducens nerve palsy were still unresolved. Although malignant lymphoma originated at the clivus is uncommon, according to a presenting case as well as previously reported cases, lymphoma can present as an isolated involvement in the clivus associated with headache, and bilateral abducens nerve palsy. It is suggested that the clivus tumor affected the petroclival segment of abducent nerve in our case.