A 13 year old black male patient with a T-cell lymphoma who presented with Gradenigo syndrome is reported from the Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA. There was a seven day history of headache described as right-sided, throbbing pain, posterior to the eye and associated with right-sided facial numbness. After five days he developed double vision on right lateral gaze and marked decrease of pinprick sensation of the entire right face and loss of the right corneal reflex. Red glass testing confirmed diplopia from a weakness of the right lateral rectus muscle. CT revealed dural enhancement in the medial aspect of the right middle cranial fossa adjacent to the sella turica. MRI showed the right internal carotid artery compressed and encased by the mass and the Meckel’s cave segment of the trigeminal nerve was obliterated. A transphenoidal biopsy provided the diagnosis of T-cell lymphoma, Lennert type, and further evaluation revealed diffuse involvement of bone marrow, spleen, kidneys, and testes. Immunologic workup showed hypogammaglobulinemia. Chemotherapy and radiotherapy resulted in completed resolution of all symptoms and signs. 
COMMENT. Gradenigo syndrome consists of cranial nerve VI palsy and abnormalities of the sensory component of ipsilateral cranial nerve V. Gradenigo described the symptom complex with middle ear infections and it has been reported as a result of tumors, most commonly neurofibroma. The primary neurologic presentation of lymphoma was unique and a new etiology for Gradenigo syndrome.