Cerebral B-cell lymphoma following treatment for Tolosa-Hunt syndrome

We herein report a unique case of cerebral lymphoma which occurred after ly mphocytic neuritis of cranial nerves causing Tolosa-Hunt syndrome and demon strate the histological difference between these two diseases. A 70-year-ol d woman developed a sensory disturbance in the first and third divisions of the left trigeminal nerve and a left ocular movement disturbance five year s before death. Although she was clinically diagnosed to have a schwannoma in the left cavernous sinus, a histologic examination verified a diffuse in filtration of T lymphocytes in the left trigeminal ganglion. Corticosteroid therapy was effective.. Thereafter she demonstrated a disturbance of consc iousness and dysphasia four years after surgery. A T1-weighted magnetic res onance image (MRI) disclosed high intensity lesions in both the basal gangl ia and corpus callosum. She also showed progressive spastic paralysis. At a utopsy a diagnosis of primary intracranial B-cell lymphoma was made. Althou gh there was no invasion of the lymphoma cells into the left trigeminal ner ves, a mild inflammatory infiltration of T cells still remained.