Facial Palsy in a Patient with Non-Hodgkin's Lymphoma

Abstract

A 60-year-old woman was admitted to a hospital in May 1986 because of bilateral cervical lymphadenopathy and tonsillar swelling. She had a 10-year history of diabetes mellitus. Biopsy of left cervical lymph nodes revealed that she had non-Hodgkin's lymphoma (diffuse, large cell; clinical stage IVA). She developed left peripheral facial palsy thereafter and was referred to our hospital for further evaluation and treatment in July 1986. On physical examination, bilateral cervical, axillary, and inguinal lymphadenopathies and tonsillar swelling were noted. There was, however, no hepatosplenomegaly. In addition to paralysis of all the left facial mimic muscle, salivation and taste perception on the posterior part of the left half of the tongue were impaired. She had no problems of hearing and lacrimation. There were no meningeal signs. Lymphoma cells were recognized in the bone marrow aspirates. While systemic lymph nodes were markedly reduced in size by two courses of chemotherapy which included vincristine, cyclophosphamide, prednisolone, and adriamycin, the facial palsy was not changed at all. A lumbar puncture showed an elevated intracranial pressure of 210 mmH₂O, slightly increased protein level of 42mg/dl, and a few lymphoma cells on a Cytospin-preparation. Two intrathecal injections of 10mg methotrexate resulted in dramatic improvement in the facial palsy. These findings suggest that the facial palsy was not due to direct pressure on the nerve by enlarged tumor mass but due to nerve infiltration by tumor cells from the direction of the central side.