68yr old female presented with migraine like headache for about 2wks with numbenss around her chin and V1 aspect of her head.Clinical examiantion was unremarkable .
Her CT brain was normal and MRI images were also normal except for GAD enhancing right trigeminal nerve.Her LP showed lymphocytosis and increased proteins.CSF cultures were normalfor bacteria,virua and fungus.CT chest,abdomen and pelvis were normal.
Her headache continued to get worse and in the third week she developed numbness of her bottoms one episode of fecal incontinence.Repeat CSF showed a similar result.
MRI of the whole spine showed GAD enchancing lepto menineal changes in the lumbosacral region.
The third LP was done and the CSF flow cytometry showed B cell lymphoma with out any evidence even in the bone marrow involvement.
Diagnosis --Leptomeningeal Lymphoma presenting as Headache and Numb chin syndrome.