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International neurological journal 8 (70) 2014

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Clinical Case Of Multifocal Mononeuropaty In Patient With Non-Hodgkin''s Lymphoma

Authors: Kuchnir G.M., Savchuk E.A., Ioshina N.N., Novikov N.Y., Kuzina O.S., Berezhnoy A.V.

Categories: Neurology

Sections: Clinical researches

print version

The problem of malignant lymphoproliferative diseases within the last decades had taken on special significance due to the progressive expansion of their frequency in the structure of hematological neoplasms.
Lymphoma is a type of hematological neoplasms that may develop in the lymph nodes, spleen, bone marrow, blood or other organs.
There are two main large groups: the first group consists of the B cell and T cell non-Hodgkin lymphomas (NHLs), and the second - Hodgkin's lymphoma, also known as  Hodgkin's disease
In recent years, the incidence of NHLs is constantly growing,  it has been increased by more than 50% over the past 20 years
The nervous system is  affected  in 5% - 29% of patients with NHL, and in about 5% -10% of cases the peripheral nervous system is involved.
Types of NHL vary significantly in their severity, from indolent to very aggressive. 
Likehood of neurological complications is linked to the different subtypes of NHL: the aggressive NHL causes neurological disorders in 4.5% - 24.5% of cases, indolent lymphomas only 1% -3% of cases, mainly after histological transformation to aggressive lymphoma subtype.
Neurological manifestations may develop as a result of lymphoproliferative process in the brain, lymphomatous infiltration and compression of the peripheral nervous system structures or due to paraneoplastic and dismetabolic disorders.
This great pathogenetic heterogeneity can be related to the variety of clinical syndromes that can occur in patients with NHL.
The most common neurological impairments are psychoautonomic disorders, cochle-vestibular failure, different pain syndromes, pyramidal insufficiency, peripheral neuropathy, light and mild cognitive impairment.
We report the case of mononeuritis multiplex as a presentation of an non-Hodgkin's lymphoma in a 43 year old patient. 
Mononeuritis multiplex was the dominant feature in the clinic  which makes the patient seek medical care.
However, revealed multiple organ disorders (lymphadenopathy, progressive anemia, thrombocytopenia, hemorrhagic syndrome) forced to search for the underlying malygnancy and to establish a causal link between lymphoma and lesions of the peripheral nervous system structures.
Thus, neurological disorders  associated with NHL are nonspecific, and present a great clinical heterogeneity, making them difficult to diagnose and worsening prognosis of the main desease.
This case shows that lymphoma should be included  in the differential diagnosis of mononeuritis multiplex when other causes cannot be found.

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