Description

We are reporting a unique combination of peripheral sciatic nerve infiltration and cranial abducent and facial nerve palsies in a case of mononeuritis multiplex in Non- Hodgkins Lymphoma in remission. This development in pre-existing left hemiplegia due to presumed vasculitis is due to  imultaneous involvement of central and peripheral nervous systems by vasculitis and infiltration respectively and represents an unusual unreported pattern of involvement in Non-Hodgkins lymphoma. The cranial element may mimic an extending brain stem CVA and preclude antemortem diagnosis of a wide spectrum of nervous system involvement by the dual pathological processes of infiltration of nerves and vasculitis. This clinical failure reflects the extremely high incidence of 46% post mortem histopathological diagnosis. Only a high index of clinical suspicion matched by due clinical diligence, judicious imaging and appropriate biopsy can avoid this eventuality and improve the antemortem diagnosis.