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Multiple Neurologic Deficits and Cognitive Decline in a Young Woman.

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This case study highlights a rare, undiagnosed neurological disorder presenting with facial palsy, mononeuritis multiplex, and cognitive decline. Prompt diagnosis is crucial for managing this rapidly progressive, fatal condition.

Keywords:
CNS lymphomaClinico-pathologic conferencelymphomatoid granulomatosismultiple neurologic deficitsneurosarcoidosis

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Area of Science:

  • Neurology
  • Pathology
  • Internal Medicine

Background:

  • A 34-year-old female presented with a 14-year history of facial palsy.
  • She developed progressive neurological deficits including mononeuritis multiplex, maculopapular rash, pancytopenia, splenomegaly, lung involvement, and cognitive decline over three years.

Purpose of the Study:

  • To present a challenging clinicopathologic case of a rapidly progressive, undiagnosed disease.
  • To discuss the diagnostic workup and clinical manifestations.

Main Methods:

  • Clinical case presentation and review of investigations.
  • Laboratory tests revealed pancytopenia, reversed albumin globulin ratio, and positive antinuclear antibody (ANA).
  • Cerebrospinal fluid (CSF) analysis showed an inflammatory profile, and MRI revealed extensive hemorrhagic lesions with mass effect.

Main Results:

  • The patient exhibited pancytopenia, mediastinal adenopathy, and low C3 complement levels.
  • Cerebrospinal fluid analysis indicated inflammation.
  • Brain MRI demonstrated significant hemorrhagic lesions and mass effect.

Conclusions:

  • The case illustrates a rare, rapidly fatal, and undiagnosed systemic disease with multi-organ involvement.
  • The diagnostic challenges and importance of comprehensive investigation in complex neurological cases are emphasized.