Abstract
Objectives Neurolymphomatosis describes the direct infiltration of nerves by malignant lymphocytes.1
Methods Case series of 3 patients at one institution.
Results A 73-year-old male with a background of inactive Non-Hodgkins Lyphoma (NHL) with progressive lower limb asymmetrical wasting and weakness punctuated by significant neuropathic pain and autonomic features. Examination revealed hip and knee flexion weakness bilaterally with milder knee and ankle extension weakness with depressed left knee and ankle reflexes. Lower limb electrophysiological (EP) testing revealed an asymmetrical sensorimotor neuropathy. A sural nerve biopsy showed severe axonal neuropathy. PET Scan showed a perineural involvement of the S1 nerve, and hypermetabolism involving cerebral lesions and a peritibial soft tissue lesion, the latter which was biopsied and confirmed NHL recurrence.
A 40-year-old male with a 1.5 month history of lower limb weakness and neuropathic pain, on a background of Acute Lymphoblastic Leukaemia (ALL) in remission. EP studies demonstrated absent S1 H-reflexes bilaterally with preserved sural responses whilst evoked potentials (EPs) were prolonged indicating a polyradiculopathy. CSF studies revealed a relapsed ALL.
An 86-year-old female with progressive right-sided arm and leg sensory symptoms and weakness associated with multidirectional diplopia. Examination revealed right upper and lower limb wasting and weakness with abduction weakness in both eyes. EP studies showed asymmetrical demyelinating polyneuropathy and delayed visual EPs bilaterally. MRI and PET revealed changes involving the oculomotor nerves, right brachial and sacral plexus and nerve roots. Biopsy of a psoas mass revealed NHL.
Conclusion The spectrum of neurological presentations is vast in patients with neurolymphomatosis.
Reference
Gan HK, Azad A, Cher L, Mitchell PL. Neurolymphomatosis: diagnosis, management, and outcomes in patients treated with rituximab. Neuro Oncol. 2010;12(2):212–215. doi:10.1093/neuonc/nop021
