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[A case of rapidly progressive T cell type malignant lymphoma which started with multiple cranial neuropathy]
T Fukusako1, T Mochizuki, K Negoro
1Department of Neurology, Yamaguchi University School of Medicine.
Abstract:
A 35-year-old man had suffered from recurrent right trigeminal nerve palsy and flaccid paraparesis for about five months. Cerebrospinal fluid (CSF) showed a marked increase of protein (400 mg/dl) and mononuclear cells (146/mm3), but there were no malignant cells. Antibiotic therapy remitted his inguinal and mediastinal lymph nodes swelling, and trigeminal nerve palsy had recovered spontaneously. Then he developed left trigeminal and facial nerve palsy, mononeuropathy multiplex, and cauda equina syndrome. Nerve conduction studies revealed delayed velocity and reduction of amplitude. Enhanced magnetic resonance imaging showed increased signal intensity in bilateral trigeminal nerves, left internal auditory meatus, and meninges of the basal cistern. Also, there were two mass lesions in cauda equina. They were operated by orthopedist, and were not malignant. After that, CSF cells of malignant lymphoma were elevated and revealed T cell type (large cell). Then the patient exacerbated in bulbar palsy and died. When there is lymph node swelling with multiple neurological deficits, despite remission of lesions and signs, biopsies should be positively pursued early in the patient's clinical course.
Insights
This case highlights a rare T-cell lymphoma presenting with recurrent neurological deficits. Early biopsy is crucial for diagnosing lymph node swelling with multiple neurological issues, even with temporary symptom remission.
Area of Science:
- Neurology
- Oncology
- Pathology
Background:
- Trigeminal nerve palsy and paraparesis can indicate serious underlying conditions.
- Recurrent neurological deficits necessitate thorough investigation.
- Cerebrospinal fluid analysis is vital in diagnosing neurological disorders.
Observation:
- A 35-year-old male presented with recurrent trigeminal nerve palsy and paraparesis.
- Initial symptoms improved with antibiotics, but later recurred with cranial and spinal nerve involvement.
- Magnetic resonance imaging revealed nerve and meningeal enhancement, and cauda equina mass lesions.
Findings:
- Cerebrospinal fluid initially showed elevated protein and cells, later revealing malignant T-cell lymphoma.
- Nerve conduction studies indicated significant nerve damage.
- Surgical removal of cauda equina lesions did not prevent disease progression.
Implications:
- This case underscores the importance of early biopsy in patients with lymphadenopathy and neurological deficits.
- Prompt diagnosis and treatment of T-cell lymphoma are critical for patient outcomes.
- The presentation highlights the diverse neurological manifestations of lymphoma.