Neurolymphomatosis presenting as brachial plexopathy with involvement of cranial nerves

Hye Jung Lee; Keun Soo Kim; Pamela Song; Jae-Jung Lee; Jung-Joon Sung; Kyomin Choi; Bohyun Kim; Joong-Yang Cho

doi:10.14253/acn.2018.20.1.44

Journal List > Ann Clin Neurophysiol > v.20(1) > 1099522

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Lee, Kim, Song, Lee, Sung, Choi, Kim, and Cho: Neurolymphomatosis presenting as brachial plexopathy with involvement of cranial nerves

Case Report

Ann Clin Neurophysiol 2018;20(1):44-48.

Published online: 5 January 2018

DOI: https://doi.org/10.14253/acn.2018.20.1.44

Neurolymphomatosis presenting as brachial plexopathy with involvement of cranial nerves

Hye Jung Lee¹, Keun Soo Kim¹, Pamela Song¹, Jae-Jung Lee¹, Jung-Joon Sung², Kyomin Choi³, Bohyun Kim⁴, Joong-Yang Cho¹

¹Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea

²Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea

³Department of Neurology, Konkuk University Medical Center, Seoul, Korea

⁴Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea

Correspondence to Joong-Yang Cho Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, 170 Juhwa-ro, Ilsanseo-gu, Goyang 10380, Korea Tel: +82-31-910-7929 Fax: +82-31-910-7368 E-mail: joongyangcho@gmail.com

Received 23 June 20175 September 2017 Accepted 25 September 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Neurolymphomatosis (NL) is a rare disease characterized by lymphomatous invasion of the cranial or peripheral nerves by lymphoma. A high suspicion is important due to the various presenting symptoms mandating consideration of many differential diagnoses. We report a case of NL of the cranial nerves and plexus presenting as diplopia, facial palsy, and weakness of the upper and lower limbs in sequence.

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Keywords: Neurolymphomatosis, Cranial nerves, Plexus

REFERENCES

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Fig. 1.

Brain and spinal MRI showed thickening and enhancement on the left facial nerve (arrow) (A), and the left brachial plexus (arrow) (B). Initial PET-CT showed mild linear FDG uptake along the left brachial plexus (arrow) (C). Brain MRI revealed multifocal leptomeningeal enhancement of the systemic lymphoma or metastasis (D). FDG-PET revealed intense uptake in the brachial (arrows) (E) and lumbosacral (arrows) (F) plexus. MRI, magnetic resonance imaging; PET-CT, positron emission tomography–computed tomography; FDG, fluorodexoyglucose.

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Fig. 2.

Biopsy of the C7 root showed infiltration by predominantly small lymphocytes (hematoxylin-eosin stain, original magnification ×200) (A), and diffuse CD20-positive cells (immunohistochemical stain, original magnification ×200) (B).

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Table 1.

Electrophysiological findings at the first symptoms of left upper limb weakness

Nerve (right/left)	Segments	Motor			Sensory
Nerve (right/left)	Segments	TL (msec)	NCV (m/sec)	Amp (mV)	NCV (m/sec)	Amp (μV)
Median	F-W	2.6/3.1		14.6/14.0	46/42	42/42
	W-E		53/56	14.1/13.4	55/58	54/58
	E-Ax		56/65	13.7/13.0	64/63	61/63
	F-latency	23.1/23.3
Ulnar	F-W	2.0/2.4		18.7/15.6	48/42	32/42
	W-E		63/58	17.2/12.8	63/62	29/33
	E-Ax		64/58	16.7/12.1	72/65	47/27
	F-latency	23.7/23.7
Axillary		3.1/4.0		29.3/4.2
Musculocutaneous		4.4/10.1		10.2/1.0
Peroneal	Fo-A	3.6/4.0		3.2/4.5
	A-FH		46/44	2.9/3.1
	K-PF
	F-letency	46.6/44.2
Tibial	Fo-A	3.5/3.7		23.5/17.0
	A-K		45/48	18.0/12.8
	F-latency	43.1/46.2
	H-reflex			29.8/29.5
Sural					39/38	27.9/24.9

TL, terminal latency; NCV, nerve conduction velocity; Amp, amplitude; F, finger; W, wrist; E, elbow; Ax, axilla; Fo, foot; A, ankle; FH, fibular head; K, knee; PF,

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