Lymphoma with Bilateral Contrast Enhancement and Restricted Diffusion of Multiple Cranial Nerves in MRI

We present a 50-year-old female with paresthesia on the right side of her face, facial asymmetry, hearing loss, and difficulty in walking. After clinical and radiological evaluations, non-Hodgkin lymphoma type B has been diagnosed. Cranial MRI revealed contrast enhancement of 3rd, 5th, 7th, and 8th cranial nerves bilaterally. Diffusion-weighted imaging (DWI) revealed prominent hyperintense symmetric cranial nerves involvement with corresponding signal reduction on Apparent Diffusion Coefficient (ADC) maps. In lymphoma cases, any of the 12 cranial nerves may be affected. Although such clinical phenomena have been described previously, this is the first patient to demonstrate restricted diffusion related to multiple cranial nerves.