Presentation
Right sided weakness and facial droop
Patient Data
1. Left thalamic hemorrhage (presumed hypertensive) with small volume intraventricular extension, accounting for the acute presentation.
2. Incidental finding of a bland left infra-temporal fossa mass with thickening of the infra-orbital nerve and V2. There is widening of the infra-orbital canal and foramen rotundum and loss of the normal fat in the pterygopalatine fissure. Remodeling of posterior wall of the maxillary antrum and adjacent pterygoid plates suggests a fairly indolent process.
Case Discussion
The incidental and asymptomatic infratemporal fossa mass lesion was biopsied and histology revealed follicular lymphoma.
The case exemplifies the risk of satisfaction of search. The thalamic hemorrhage explains the presentation but careful assessment of review areas (in this case the soft tissues below the skull base) reveals a further significant pathology.
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