Presentation
Decreased hands sense and motions after iliac bone non-Hodgkin lymphoma chemotherapy.
Patient Data
Pathologically enlarged and infiltrated third, fourth, fifth, sixth and ninth cranial nerves with obliteration of Meckel caves and cavernous sinuses, more prominently on the right.
Vivid contrast enhancement of the cisternal portions of both trigeminal nerves, all nerves passing through cavernous sinuses, glosso-pharyngeal nerves, also notes all portions of the left facial nerve enhancement.
The pituitary gland is enlarged and infundibulum prominent.
There are no brain lesions.
Heterogenous hypointense T2 signal of the swollen cervical nerve roots with lateral recess obliteration. Brachial plexus nerve enlargement is more prominent on the left.
Obliterated Meckel caves and cavernous sinuses by diffuse nerve infiltration.
Enlarged cervical radices and brachial plexus nerves.
Case Discussion
Diffuse asymmetric cranial nerve infiltration and enlargement may mimic a mass like a Meckel cave meningioma. Because of prior chemotherapy for non-Hodgkin lymphoma, the differential diagnosis should include a rare distribution of neurolymphomatosis as well as post-treatment changes. Contrast administration is helpful and can differentiate one from the other by vivid contrast enhancement due to lymphomatous infiltration of cranial nerves.
MRI alone has a low sensitivity for neurolymphomatosis diagnosis, which is about 40%. Here we have such one. It's important to visualize diffuse cranial and peripheral nerve changes in patients with non-Hodgkin lymphoma for early and successful treatment. FDG PET has a higher sensitivity and accuracy for detecting neurolymphomatosis. But knowing patient history, clinical findings of polyneuropathy and cranial nerves deficit MRI with contrast is also a good modality for diagnosing extremely rare conditions related to non-Hodgkin lymphoma.
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