Spontaneous Oculomotor and Abducens Nerve Palsy as Initial Presentation of Lymphoma of the Cavernous Sinus: Case Report

Abstract

Primary lymphomas of the skull base are rare (1% of lymphomas in adults); they can originate from the cavernous sinus and the parasellar region. Diffuse large B-cell lymphoma is the most common histologic subtype. Currently, the origin of these lymphomas is controversial, and their clinical characteristics are not very specific. There are various treatments for these lesions with a variable response; therefore, the prognosis of these lesions is variable. Clinical case: We present the case of a 52-year-old man who spontaneously presented with diplopia. Physical examination revealed a limitation in adduction of the right eye, right palpebral ptosis, and limitation in the abduction of the left eye. Brain magnetic resonance imaging revealed a well-defined and homogeneous extra-axial lesion at the cavernous sinus level. The patient was biopsied and diagnosed with B-cell lymphoma; received chemotherapy and radiotherapy. In this article, we present a clinical case that considers the characteristics of the diagnosis and is the first B-cell lymphoma at the cavernous sinus level reported in Mexico. Conclusion: Skull base lymphomas have a broad clinical spectrum. Minimally invasive surgery for biopsy purposes is the gold standard for diagnosis, and the treatment with the best results is chemotherapy.