Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

Malignant lymphoma presented as left trigeminal neuralgia

Miho Akaza, M.D.1), Taiji Tsunemi, M.D.1), Nobuo Sanjo, M.D.1), Hiroaki Wakimoto, M.D.2), Daisuke Kobayashi, M.D.3) and Hidehiro Mizusawa, M.D.1)

1)Department of Neurology and Neurological Science, Graduate School, Tokyo Medical and Dental University
2)Department of Neurosurgery, Graduate School, Tokyo Medical and Dental University
3)Department of Pathology, Graduate School, Tokyo Medical and Dental University

A male, 60 years of age, presented with transient left facial pain located within all three divisions of the trigeminal nerve. Magnetic resonance imaging (MRI) revealed a swollen left trigeminal nerve with gadolinium enhancement. Following schwannoma diagnosis, the patient received Gamma Knife radiosurgery, which proved effective against symptoms of neuralgia and enhanced lesions. A relapse of unsteadiness was noted 11 months after initial treatment. Furthermore, while MRI presented a normal trigeminal nerve, multiple enhanced white matter mass lesions around the lateral ventricles were observed. Lastly, pathological examinations revealed diffuse large B cell lymphomas. The administration of high-dose methotrexate followed with whole brain radiation therapy appeared to have remarkable effects. No recurrences were observed in a 30 month duration following secondary treatment. Malignant lymphoma may present as trigeminal neuralgia. The conclusions from our case report and another literature review follow a difficult to near impossible task of establishing a correct diagnosis without biopsy in the initial stages of trigeminal nerve tumors. Therefore, a careful MRI follow-up is necessary even if the tumors show a favorable response towards primary steroid treatment or Gamma Knife radiosurgery.
Full Text of this Article in Japanese PDF (571K)

(CLINICA NEUROL, 49: 432|436, 2009)
key words: trigeminal nerve, malignant lymphoma, gamma knife

(Received: 11-Nov-08)