title: A 43-year-old woman presenting with subacute, bilateral, sequential facial nerve palsies, then developing pseudotumour cerebri.
abstract: 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.
authors.affiliation: Department of ENT, RPA Hospital, Sydney, New South Wales, Australia.
authors.forename: Laura
authors.initials: L
authors.lastname: O'Connor
authors.affiliation: Department of ENT, RPA Hospital, Sydney, New South Wales, Australia.
authors.forename: Glen
authors.initials: G
authors.lastname: Croxson
authors.affiliation: Department of Ophthalmology, RPA Hospital, Sydney, New South Wales, Australia Sydney Medical School, University of Sydney, New South Wales, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: McCluskey
authors.affiliation: Department of Neurology, RPA Hospital, Sydney, New South Wales, Australia.
authors.forename: Gabor Michael
authors.initials: GM
authors.lastname: Halmagyi
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D020330:Bell Palsy / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D059248:Chemoradiotherapy; D002908:Chronic Disease; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D057210:Delayed Diagnosis; D003907:Dexamethasone / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000150:complications; D016393:Lymphoma, B-Cell / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008416:Mastoid / Q000473:pathology*; D008727:Methotrexate / Q000008:administration & dosage; D009896:Optic Atrophy / Q000150:complications / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D010035:Otitis Media, Suppurative / Q000209:etiology* / Q000473:pathology; D010211:Papilledema / Q000209:etiology*; D011559:Pseudotumor Cerebri / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D012851:Sinus Thrombosis, Intracranial / Q000150:complications* / Q000175:diagnosis; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage; D015354:Vision, Low / Q000209:etiology
chemical_list: D000925:Anticoagulants; D000964:Antimetabolites, Antineoplastic; D003561:Cytarabine; D014750:Vincristine; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D008727:Methotrexate