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Case Report ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurol. | doi: 10.3389/fneur.2019.00004


Wijdan Rai1, Vanessa Olcese1,  Bakri Elsheikh1 and  Amro M. Stino1*
  • 1The Ohio State University, United States

Introduction: Horner’s syndrome is an established clinical finding unique to neoplastic brachial plexopathy.

Background: We present the case of a patient who developed Horner’s syndrome as the first manifestation of neurolymphomatosis (NL) of the brachial plexus that did not have the usually associated bulky adenopathy / Pancoast syndrome phenotype.

Discussion: We discuss the clinical utility of Horner’s syndrome with regards to brachial plexopathy of indeterminate etiology, as well as the utility of other diagnostic modalities in NL.

Concluding remarks: NL, particularly of the brachial plexus, is particularly challenging to diagnose. MRI and CSF studies are often inconclusive. FDG-PET imaging can be difficult to get insurance to approve. The presence of Horner’s syndrome in brachial plexopathy of indeterminate etiology, even in the absence of bulky adenopathy, should raise clinical suspicion of NL, possibly prompting such interventions as fascicular nerve biopsy.

Keywords: Lymphoma, Horner's syndrome, Non-Hodgkin B cell lymphoma, CSF, Brachial plexopathy, diffuse large B cell lymphoma

Received: 22 Oct 2018; Accepted: 03 Jan 2019.

Edited by:

Angelo Schenone, Università di Genova, Italy

Reviewed by:

Raghav Govindarajan, University of Missouri, United States
Chiara Briani, Department of Neuroscience, University of Padova, Italy  

Copyright: © 2019 Rai, Olcese, Elsheikh and Stino. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Amro M. Stino, The Ohio State University, Columbus, United States,