A 43-year-old woman presenting with subacute, bilateral, sequential facial nerve palsies, then developing pseudotumour cerebri

A patient presented elsewhere with what appeared to be a simple, unilateral, chronic suppurative otitis media and then developed an ipsilateral facial palsy. She soon developed the same problem on the other side. At the time, a brain MRI had been ordered but the clinician did not review it with a ra...

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Bibliographic Details
Published in:BMJ case reports 2015-11, Vol.2015, p.bcr2015211399
Main Authors: O'Connor, Laura, Croxson, Glen, McCluskey, Peter, Halmagyi, Gabor Michael
Format: Article
Language:English
Subjects:
Adult
Anticoagulants - administration & dosage
Antimetabolites, Antineoplastic - administration & dosage
Antineoplastic Combined Chemotherapy Protocols - administration & dosage
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Australasia
Bell Palsy - drug therapy
Bell Palsy - etiology
Bell Palsy - physiopathology
Bones
Chemoradiotherapy
Chronic Disease
Cyclophosphamide - administration & dosage
Cytarabine - administration & dosage
Delayed Diagnosis
Dexamethasone - administration & dosage
Doxorubicin - administration & dosage
Ears & hearing
Female
Hearing loss
Histopathology
Humans
Hypertension
Intracranial Hypertension - complications
Lymphoma
Lymphoma, B-Cell - complications
Lymphoma, B-Cell - drug therapy
Lymphoma, B-Cell - pathology
Magnetic Resonance Imaging
Mastoid - pathology
Medical imaging
Methotrexate - administration & dosage
Neurological disorders
Optic Atrophy - complications
Optic Atrophy - drug therapy
Optic Atrophy - etiology
Optic Atrophy - pathology
Otitis Media, Suppurative - etiology
Otitis Media, Suppurative - pathology
Papilledema - etiology
Pseudotumor Cerebri - drug therapy
Pseudotumor Cerebri - etiology
Pseudotumor Cerebri - pathology
Reminder of Important Clinical Lesson
Sinus Thrombosis, Intracranial - complications
Sinus Thrombosis, Intracranial - diagnosis
Sinuses
Thrombosis
Treatment Outcome
Vincristine - administration & dosage
Vision, Low - etiology
White
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Summary:A patient presented elsewhere with what appeared to be a simple, unilateral, chronic suppurative otitis media and then developed an ipsilateral facial palsy. She soon developed the same problem on the other side. At the time, a brain MRI had been ordered but the clinician did not review it with a radiologist. The surgical specimens were not sent for histopathology. When transferred to our institution 3 months later, the patient had severe bilateral papilloedema due to intracranial hypertension due to missed cerebral venous sinus thrombosis. Further surgery revealed that the pathology in the temporal bone was B-cell lymphoma, which, fortunately, responded to chemoradiotherapy. There was good resolution of the facial palsies, but the patient has severe permanent visual loss due to optic atrophy.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2015-211399