Hirose Takahiko, Nakajima Hideto, Shigekiyo Tarou, Yokote Taiji, Ishida Shimon, Kimura Fumiharu
Division of Neurology, Department of Internal Medicine I, Osaka Medical College.
Rinsho Shinkeigaku. 2016;56(1):48-50. doi: 10.5692/clinicalneurol.cn-000802. Epub 2015 Nov 30.
We report the case of a 62-year-old man who presented with malignant lymphoma as recurrent multiple cranial nerve palsy after spontaneous regression of oculomotor nerve palsy. He developed ptosis and diplopia due to right oculomotor nerve palsy. Brain MRI/MRA showed no abnormality, and he recovered with conservative medical management. Three months later, he showed diplopia due to right abducens nerve palsy and facial pain and trigeminal sensory loss. Neurological examination revealed multiple cranial nerve palsy involved cranial nerve III, V, IX, and X of the right side. Serum soluble interleukin-2 receptor levels were normal, and cerebrospinal fluid examination was unremarkable. Steroid and subsequent intravenous immunoglobulin therapy didn't improve his symptoms. Six weeks after his admission, he showed rapid enlargement of the cervical lymph node and the right tonsil, and post-contrast T1-weighted MRI showed enlargement and enhancement of the left infraorbital nerve, the bilateral cavernous sinus, the bilateral facial nerves, and the left trigeminal nerve. The histopathologic examination of the tonsil biopsy revealed diffuse large B cell lymphoma. The cause of these symptoms was thought to be infiltrating the cavernous sinus, and adjacent nerves. Spontaneous regression of malignant lymphoma is an exceptional event, but this possibility should be considered so as to the correct diagnosis and proper treatment.
我们报告了一例62岁男性患者，其在动眼神经麻痹自发消退后，以复发性多颅神经麻痹形式出现恶性淋巴瘤。他因右侧动眼神经麻痹出现上睑下垂和复视。脑部MRI/MRA未显示异常，经保守药物治疗后康复。三个月后，他因右侧展神经麻痹、面部疼痛和三叉神经感觉丧失而出现复视。神经系统检查发现右侧的动眼神经、三叉神经、舌咽神经和迷走神经有多发性颅神经麻痹。血清可溶性白细胞介素-2受体水平正常，脑脊液检查无异常。类固醇及随后的静脉注射免疫球蛋白治疗均未改善其症状。入院六周后，他的颈部淋巴结和右侧扁桃体迅速肿大，增强后T1加权MRI显示左侧眶下神经、双侧海绵窦、双侧面神经和左侧三叉神经肿大并强化。扁桃体活检的组织病理学检查显示为弥漫性大B细胞淋巴瘤。这些症状的原因被认为是淋巴瘤浸润海绵窦及相邻神经。恶性淋巴瘤自发消退是一个例外情况，但为了正确诊断和恰当治疗，应考虑到这种可能性。
