Primary lymphoma of the skull presenting as multiple cranial nerve palsies

Lymphoma presenting with isolated diffuse infiltration of the skull is exceedingly rare, with less than 20 previously reported cases. The clinical presentation of a 73-year-old female with primary lymphoma of the skull, manifesting multiple cranial nerve palsies and infiltration of the temporalis muscles is described. MRI of the head, revealed an abnormal signal from the diploic space of the call varium and skull base on both T1 and T2 weighted images, infiltration of the temporalis muscles and clivus, and diffuse meningeal enhancement encroaching on the cavernous sinus bilaterally. Biopsy of temporalis muscle and skull showed a diffuse large cell lymphoma, B-cell type. Staging workup failed to reveal any other sites of disease. Despite multiple cranial nerve palsies, there was no evidence of leptomeningeal disease on CSF examination. MRI was instrumental in demonstrating the abnormalities that lead to the diagnostic biopsy.