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

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

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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REFERENCES

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acn-20-44f1.tif
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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acn-20-44f2.tif
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
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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