Multiple Cranial Neuropathies With a Skull Base Mass-like Lesion – A Rare Case of CNS Involvement of SLL
Saad Umar1, Jason Schick2, Muhammad Farooq2
1Ross School of Business, University of Michigan, 2Hauenstein Neurosciences, Trinity Health Grand Rapids
Objective:
To present a case of CNS involvement of SLL, manifesting as cranial nerve V and VII palsies.
Background:
Chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL) are both mature B cell neoplasms and considered to be the same entity with different manifestations. CLL is characterized by manifestation primarily within the blood, while SLL is characterized by primary nodal involvement. Virtually any lymphoid tissue can be involved, though CNS involvement is rare, occurring in less than 2% of patients.
Results:
A 77-year-old male presented with 8 months of progressive left facial pain and weakness. His medical history was significant for CLL diagnosed 9 years prior. He was treated with chemotherapy, with his CLL felt to be inactive for the last 8 years.
His neurologic exam was significant for impaired pinprick sensation of the left half of the face, with left facial weakness in a lower motor neuron pattern. MRI brain with and without contrast was ordered, revealing a 2 x 1 cm area of enhancement within the left Meckel’s cave, extending into the left prepontine cistern, with adjacent pachymeningeal enhancement. LP was completed with normal CSF analysis including flow cytometry and cytology. A CT of the chest/abdomen/pelvis showed widespread lymphadenopathy, with later lymph node biopsy consistent with SLL. Despite negative CSF flow cytometry, he was diagnosed with SLL with CNS involvement based on imaging characteristics and clinical history.
Conclusions:
Here we present a case of multiple cranial neuropathies secondary to CLL/SLL. Despite the overall rarity of CNS involvement in CLL/SLL, the most common site of CNS involvement is the meninges, as demonstrated here. A high level of suspicion for meningeal involvement of malignancy is needed in patients presenting with multiple cranial neuropathies, especially in patients with a known history of malignancy, even if that malignancy rarely has CNS involvement, such as CLL/SLL.
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