Isolated oculomotor nerve palsy as a manifestation of diffuse large B cell lymphoma: A case report

Khaleefah, Muntadher M; Narayanan, Siddharth; Dallal, Hiba A Al; Jones, Christopher M.; Friedland, Robert P.; Palade, Adriana; Remmel, Kerri; Shah, Jignesh

doi:10.3892/ol.2020.12147

Cited by 9 publications

(6 citation statements)

References 19 publications

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“…More importantly, ITCNP has also been reported to occur in diffuse large B cell lymphoma, Burkitt lymphoma, multiple myeloma and metastatic pancreatic carcinoma, which are important to exclude. [28][29][30] None of these were found in our patients during the study period.…”

Section: Discussionmentioning

confidence: 52%

Isolated Third Cranial Nerve Palsy: Aetiology - Clinical Profile and Recovery at a Tertiary Neuro-ophthalmology Centre on the East Coast Peninsular of Malaysia

Nurul-Ain

Hitam

Shatriah

et al. 2022

J Health Sci Med Res

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Objective: This study aimed to study the aetiologies, clinical profile and recovery of isolated third cranial nerve palsy (ITCNP) patients, at a tertiary neuro-ophthalmology center on the East Coast Peninsular of Malaysia. Material and Methods: This was a retrospective study, involving 33 patients with newly diagnosed ITCNP, who were treated at the Hospital of the Universiti Sains, Malaysia; from January 2018 to December 2019, with a follow up period ranging from 18 to 24 months. The demographic data, clinical features and aetiologies of the patients were analysed. Results: Patients’ ages ranged from 14 to 79 years (mean: 48, 50 years of age). The main aetiology was microvascular ischemia (39.4%), followed by trauma (30.3%), aneurysm (15.2%), tumour (9.1%) and undetermined cause (6.1%). Neuroimaging was performed for those indicated cases; with either computed tomography (CT), CT angiography, digital subtraction angiography, magnetic resonance imaging (MRI) with contrast or MRI angiography. Two-thirds of the patients (66.7%) had periorbital pain, which included 30.8% of patients with microvascular ischemia and 60.6% had pupil involvement; which was also found in 23.1% of patients with microvascular ischemia. Complete external third nerve palsy occurred in 18.2% of patients, and aberrant regeneration was observed in 36.4% of patients. Complete recovery occurred in 48.5%, of all patients, having microvascular ischemia and undetermined causes. Conclusion: The aetiologies, clinical profile and recovery of ITCNP patients in our institution are comparable to those reported in other previous studies. Patients with microvascular ischemia may also demonstrate periorbital pain and anisocoria. Neuroimaging remains the gold standard and the best tool via which to exclude other sinister and lifethreatening aetiologies.

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Section: Discussionmentioning

confidence: 52%

Isolated Third Cranial Nerve Palsy: Aetiology - Clinical Profile and Recovery at a Tertiary Neuro-ophthalmology Centre on the East Coast Peninsular of Malaysia

Nurul-Ain

Hitam

Shatriah

et al. 2022

J Health Sci Med Res

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“…This case is unusual as it presents a patient with cranial nerve III palsy symptoms as the initial sole physical manifestation of underlying leptomeningeal disease from NHL, which is rare with a few documented cases of episodic oculomotor nerve palsy, and usually from breast malignancy [ 11 - 12 ]. The occurrence of oculomotor nerve palsy can be considered a potential differential for an underlying cause, as in this case with imaging that did not show contrast-enhancing lesions or associated surrounding edema [ 13 - 14 ]. Furthermore, there have been documented similar cases with cranial neuropathies associated with lymphoma in the CNS but with other associated clinical features, such as leukocytosis, lymphadenopathy, or "B-symptoms," that this patient did not have.…”

Section: Discussionmentioning

confidence: 99%

Cranial Nerve III Palsy as the First Sign of Carcinomatous Meningitis From Non-Hodgkin’s Lymphoma

Velez Oquendo,

Alcantar,

Gupta

2024

Cureus

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Carcinomatous meningitis (CM) is characterized by the multifocal dissemination of malignant cells into the cerebrospinal fluid (CSF), pia mater, and subarachnoid space. Involvement can occur in the advanced stage of malignancy, causing multifocal involvement and a wide array of symptoms. Diagnosis requires suspicions and a multimodal approach that includes imaging, lumbar puncture, and diagnostic laboratory evaluation. This case represents a female with a history of non-Hodgkin's lymphoma (NHL) and venous thromboembolism on chronic anticoagulation who presented due to acute encephalopathy, hallucinations, and right cranial nerve III palsy for 10 days before arrival. Computed tomography (CT) and angiography of the brain did not show any intracranial abnormalities. Subsequent magnetic resonance imaging (MRI) was without signs of infarction, hemorrhage, or abnormal enhancement, with the MRI of the orbits showing asymmetric linear enhancement anterior to the superior pons and midbrain on the right. Initial differential included a paraneoplastic syndrome, but there was no obvious evidence of pathological enhancement on MRI. Due to progressive bulbar symptoms, a lumbar puncture was performed with cerebrospinal fluid diagnostic workup with cytology showing monoclonal B-cell proliferation consistent with lymphoma. This case illustrates a rare but specific finding of CM as cranial nerve III palsy symptoms in this patient who did not have imaging findings that would reflect her symptoms on the initial MRI of the brain. Furthermore, diagnosing CM is complex and involves a combination of multiple diagnostic and treatment modalities. It is important to recognize the condition early to improve the patient's quality of life, prolong survival, and stabilize neurological deterioration.

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“…Oculomotor nerve palsy can represent the initial manifestation in various malignant tumors. A recent study conducted in 2020 analyzed an isolated third nerve palsy presenting as the primary manifestation of a B-cell lymphoma [ 30 ]. Another study researched the case of a 72-year-old male whose final diagnosis was palsy of the oculomotor nerve by meningeal carcinomatosis in the context of urothelial carcinoma [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Complete oculomotor nerve palsy – first manifestation of gastric adenocarcinoma: clinical experience and literature review

Pavel

Costea²,

Anton³

et al. 2022

Rom J Morphol Embryol

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The diagnosis and management of the alteration of the normal function of the oculomotor nerve (third cranial nerve) varies depending on the characteristics of the paralysis, the age of the patient, and the associated symptoms and signs. Oculomotor nerve palsy may be caused by lesions located anywhere from the oculomotor nucleus to the termination of the third nerve in the extraocular muscles. Although there have been significant advances in neuroimaging to facilitate early diagnosis, the management of a patient presenting with isolated oculomotor palsy is still challenging. This review tackles the case of a 52-year-old patient, with a history of pulmonary tuberculosis (at the age of five), referred to the Department of Ophthalmology, St. Spiridon Emergency Clinical Hospital, Iaşi, Romania. The patient had diplopia accompanied by right eyelid ptosis, symptoms that began suddenly 10 days before hospitalization. The clinical examination showed right eye grade II palpebral ptosis, exotropia with limitation of eyeball movements in adduction, supra-/infraduction. Biomicroscopic examination of the anterior pole revealed the presence of anisocoria and light-near dissociation on the affected side. Numerous investigations were performed to identify the cause, starting with tumoral markers, which were within normal limits. Magnetic resonance angiography (MRA) was performed, and posterior communicating artery aneurysm was ruled out. The endocrinology examination and hormonal laboratory tests were also within normal parameters. Due to suspicions of generalized tuberculosis raised by the infectious disease doctor or presence of secondary lesions, thoraco-abdomino-pelvic computed tomography (CT) scan with contrast agent was done and its findings required gastroenterological exploration. After various explorations, the certainty diagnosis was set by histopathological examination, which revealed gastric adenocarcinoma.

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Isolated oculomotor nerve palsy as a manifestation of diffuse large B cell lymphoma: A case report

Cited by 9 publications

References 19 publications

Isolated Third Cranial Nerve Palsy: Aetiology - Clinical Profile and Recovery at a Tertiary Neuro-ophthalmology Centre on the East Coast Peninsular of Malaysia

Isolated Third Cranial Nerve Palsy: Aetiology - Clinical Profile and Recovery at a Tertiary Neuro-ophthalmology Centre on the East Coast Peninsular of Malaysia

Cranial Nerve III Palsy as the First Sign of Carcinomatous Meningitis From Non-Hodgkin’s Lymphoma

Complete oculomotor nerve palsy – first manifestation of gastric adenocarcinoma: clinical experience and literature review

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