Secondary involvement of the skull base in malignant B-cell lymphoma / 대한내과학회지

ABSTRACT

We report a case of B-cell lymphoma with multiple asymmetrical cranial nerve palsies as the initial presentation. A 70-year-old woman complained of chin numbness, diplopia, dysarthria, and headache that had developed insidiously over the previous 2 months. The neurological examination showed multiple cranial nerve dysfunction, including right V and left VI nerve palsies. Her cerebrospinal fluid was normal, while her bone marrow biopsy revealed CD20-positive B-cell lymphoma. Five days after starting R-CHOP (rituximab-cyclophosphamide, adriamycin, vincristine, prednisolone) chemotherapy, her cranial nerve palsies and pain had improved markedly. Twenty days after starting R-CHOP chemotherapy, however, she was rehospitalized due to general worsening paralysis. In the hospital, the general paralysis progressed rapidly and she lapsed into delirium. No additional treatment was given based on the directives of her guardian and herself, and she was allowed to leave the hospital for hospice care.