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Case Reports
. 2018 May 29;10(5):e2708.
doi: 10.7759/cureus.2708.

Homonymous Hemianopia: A Rare Presentation of Secondary Central Nervous System Neurolymphomatosis

Fadil Awis Qarni  1 , Evelyn Tai  1 , Wan-Hazabbah Wh  2 , Azlan Husin  3
Affiliations
Case Reports

Homonymous Hemianopia: A Rare Presentation of Secondary Central Nervous System Neurolymphomatosis

Fadil Awis Qarni et al. Cureus. .

Abstract

Neurolymphomatosis is an atypical complication of non-Hodgkin lymphoma and leukaemia involving infiltration of neurotropic neoplastic cells in the central or peripheral nervous system. A 28-year-old Malay lady with background diffuse large B-cell lymphoma stage IV presented with left homonymous hemianopia associated with cognitive function deterioration. Her best corrected visual acuity was 6/9 in both eyes. Magnetic resonance imaging (MRI) of the brain showed a lesion suggestive of secondary lymphomatous infiltration of the splenium of corpus callosum. The patient underwent chemotherapy, after which repeated MRI showed a reduction in the lesion size. Homonymous hemianopia is a rare presentation of secondary central nervous system neurolymphomatosis. A comprehensive history, physical examination, and radiological imaging are essential to establish the diagnosis in patients presenting with visual field defects.

Keywords: diffuse large b-cell lymphoma; homonymous hemianopia; lymphoma; neurolymphomatosis; non-hodgkin lymphoma.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. 30-2 Humphrey visual field perimetry
Complete left homonymous hemianopia.
Figure 2
Figure 2. Magnetic resonance imaging (MRI) of the brain
2a) T1-weighted sagittal imaging; 2b) T1-weighted axial imaging; 2c) T2-weighted axial imaging; 2d) fluid attenuation inversion recovery (FLAIR) sequence imaging. A well-defined mass is visible in the splenium of corpus callosum (white arrow), crossing the midline. The mass is isointense on T1, hyperintense on T2, and hyperintense on FLAIR. There is associated white matter oedema (black arrowheads).
Figure 3
Figure 3. 30-2 Humphrey visual field perimetry post chemotherapy
Significant improvement in the previously noted left homonymous hemianopia.
Figure 4
Figure 4. Magnetic resonance imaging (MRI) of the brain post chemotherapy
4a) T1-weighted sagittal imaging; 4b) T1-weighted axial imaging; 4c) T2-weighted axial imaging; 4d) fluid attenuation inversion recovery (FLAIR) sequence imaging. Marked reduction in the size of the previously seen mass at the splenium of corpus callosum (white arrow), ​​​​​​with reduced white matter oedema (black arrowheads).
See this image and copyright information in PMC

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