Oculomotor palsy from malignant lymphoma

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Neurologic complications of malignant lymphomas develop in 10% to 29% of all patients with lymphoma at some time during their illness.1–3 Excluding opportunistic infections, therapeutic complications to the nervous system and paraneoplastic syndromes such as PML, most neurologic manifestations are the result of direct effects of lymphoma on the nervous system. Among these, compression of the spinal cord and peripheral nerves is most often encountered. Recently, diffuse lymphomatous meningitis without localized signs has been noted to be surprisingly common in patients with non-Hodgkin's lymphomas.4, 5 Direct invasion of the cranial nerves and the brain parenchyma remains infrequent and is associated with direct extension of lesions in the base of the skull.2, 3

Neuro-ophthalmologic abnormalities are rare in patients with lymphoma and, if they occur, are mainly due to direct invasion into the orbital and ocular structures.6 However, lesions in the cavernous sinus producing oculovisual manifestations seem to be most unusual in patients with lymphoma.7, 8 We report a case of isolated right third nerve palsy as the first sign of lymphoma. Pathologic findings demonstrated localized invasion of lymphoma in the cavernous portion of the right third nerve.

Case report

A 43-year-old woman had increasing fatigue and recurrent, vague, abdominal pain for approximately one year before admission to the Cleveland Clinic Hospital. Several weeks before admission she noted the development of paresthesias and pain along the left mandible. Shortly thereafter, double vision and ptosis of the right eyelid developed without headache or pain.

Two weeks before admission, she was hospitalized . . .



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