Abstract Details

Title Isolated Bilateral Cranial Nerve Three Palsy as Unique Manifestation of CNS Spread of Burkitt Lymphoma

Topic Neurotoxicology

Presentation(s) P01 - (-)

Poster/Presentation
Number 058

Objective

Background There is limited data regarding isolated cranial nerve three palsies in patients with Burkitt lymphoma, with case reports only documented in children. There is also limited data regarding the use of radiation treatment in patients in which CNS infiltration is a diagnosis of exclusion.

Design/Methods Case report.

Results SJ is a 31yo M, with a history of HIV well controlled on HAART, who presented with a rapidly growing left sided neck mass and numb chin, who was diagnosed with c-myc positive Burkitt lymphoma with markedly hypercellular bone marrow. MRI of the brain and CSF cytology were both negative for malignancy, and systemic treatment with CODOX-M was initiated, to which the patient sustained an excellent response. One month later SJ developed diplopia, and was found to have bilateral L>R pupil sparing CNIII palsy. Repeat imaging of the brain/orbits was negative, as was CSF cytology for malignancy. Over the next month, SJ underwent three cycles of intra-thecal chemotherapy with ARA-C, Retuximab/Methotrexate, and Retuximab/Methotreaxate/ARA-C respectively, in addition to systemic chemotherapy with IVAC-R followed by R-CHOP. Three subsequent lumbar punctures revealed no malignant cells on cytology and a broad infectious work-up, with subsequent MRIs, remained negative. With no improvement noted, a trial of base of skull radiation was attempted, to which the patient sustained full recovery of his CNIII palsy.

Conclusions Thus, this case illustrates an atypical presentation of presumed CNS infiltration of Burkitt lymphoma, with a non-diagnostic work-up, which responded to radiation treatment. This may suggest a role for radiation therapy when CNS spread is suspected clinically despite a lack of positive confirmatory diagnostic testing.

Authors/Disclosures
Anne D. Yacoub, MD PRESENTER	Dr. Yacoub has received personal compensation in the range of $500-$4,999 for serving as a Consultant for AbbVie.
	No disclosure on file
	No disclosure on file
Charles A. Szabo, MD, FAAN (UT Health San Antonio)	Dr. Szabo has received personal compensation in the range of $500-$4,999 for serving as a Consultant for LivaNova. Dr. Szabo has received personal compensation in the range of $500-$4,999 for serving as an officer or member of the Board of Directors for Epilepsy Foundation of Central and South Texas. Dr. Szabo has received personal compensation in the range of $0-$499 for serving as a Reviewer with NINDS.
Per Soelberg Sorensen	No disclosure on file

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