Non-Hodgkin's lymphoma presenting with multiple cranial nerve deficits

Abstract

Background Non-Hodgkin's lymphoma (NHL) is a neoplastic disease that originates in the lymphatic system but has the potential to disseminate to the central nervous system (CNS), known as secondary CNS lymphoma (SCNSL). SCNSL most commonly involves the leptomeninges and often presents with multiple cranial nerve signs. Case report A 50-year-old black male presented to the clinic with complaints of vertigo and decreased vision in the left eye. The ophthalmic examination revealed reduced visual acuity, visual field loss, and limited abduction in the left eye. A review of the patient's medical record revealed a recent history of facial pain and numbness, as well as decreased taste. The totality of findings had a distinct neurological pattern consistent with multiple cranial nerve deficits. Subsequent neurological evaluation, neuroimaging, and laboratory testing confirmed a diagnosis of SCNSL. Conclusions Systemic NHL is capable of manifesting within the CNS during periods of progression or relapse. When NHL breaches the CNS it can present with numerous neurological deficits, some of which may be detected during ophthalmic examination. This report summarizes the ocular manifestations of SCNSL and describes a case that presented with multiple cranial nerve deficits.