ABSTRACT
Introduction: Cranial nerves, leptomeninges and cavernoussinus are often involved in lymphomas. Isolated oculomotornerve palsy as the first manifestation of a lymphoma is rare,particularly when none of its other manifestations are initiallyidentified.Case report: A 31 year old man with no known co-morbidities,came with complaints of acute onset of blurring of visionand drooping of the right eyelid. Neurological examinationrevealed isolated right medial rectus palsy with dilated pupiland ptosis of right eyelid, suggesting complete oculomotornerve palsy. CT Brain, CT Angiogram and CSF study werenormal.Chest X Ray showed mediastinal widening and CECTThorax showed anterior mediastinal mass. CT guided biopsysuggested lymphoproliferative disorder. IHC was diagnosticfor Thymoma. The mass was resected. Ten days later, thepatient returned, with worsening of his symptoms. Neurologicexamination showed third, fourth and sixth cranial nervepalsy. IHC of the resected specimen revealed high gradeB cell Lymphoblastic Lymphoma. Repeat CSF analysisshowed leptomeningeal involvement. Patient was started onchemotherapy for high grade lymphoma and his extra ocularmovements improved. One week later, he developed bilateralfacial palsy and Left CN IX, X Palsy. Chemotherapy wascontinued until he was discharged at request. Patient was lostto follow up.Conclusion: This atypical presentation of NHL can bringabout a delay in the diagnosis due to the variability of itspresenting symptoms and wide differential diagnosis. Thusearly diagnosis and aggressive management is essential.