J Neurocrit Care.  2019 Jun;12(1):55-63. 10.18700/jnc.190083.

Primary central nervous system lymphoma with intramedullary spinal cord involvement mimicking inflammatory demyelinating disease

Affiliations
  • 1Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea. nts0022@hanmail.net
  • 2Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. mlevy11@mgh.harvard.edu
  • 3Department of Pathology, Chonnam National University Medical School, Gwangju, Republic of Korea.
  • 4Department of Nuclear Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea.
  • 5Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea.

Abstract

BACKGROUND
Spinal cord involvement of primary central nervous system lymphoma (PCNSL) is rare in a young immunocompetent patient and can be misdiagnosed as an inflammatory demyelinating disease (IDD) of the central nervous system. CASE REPORT: We report a case of PCNSL mimicking IDD in a previously healthy 46-year-old man with weakness in both hands for 1 week. Magnetic resonance imaging (MRI) of the cervical spinal cord revealed contrast-enhancing intraparenchymal and leptomeningeal lesions in the cervical spinal cord and medulla oblongata. Cerebrospinal fluid analysis revealed pleocytosis (37/mm³). The patient's symptoms and lesions improved with corticosteroid treatment. However, he developed semicomatose mentality 5 months later. Brain MRI, ventricular biopsy, and ¹â¸F -flurodeoxyglucose positron emission tomography/computed tomography confirmed PCNSL. The patient deceased 3 months later, despite high-dose methotrexate chemotherapy.
CONCLUSION
Persistent gadolinium-enhancing MRI lesions along the ventricular regions and spinal leptomeninges could differentiate PCNSL involving the spinal cord from IDD in the early stages of the disease.

Keyword

Primary central nervous system lymphoma; Neuromyelitis optica; Multiple sclerosis; Spinal cord; Magnetic resonance imaging

MeSH Terms

Biopsy
Brain
Central Nervous System*
Cerebrospinal Fluid
Cervical Cord
Demyelinating Diseases*
Drug Therapy
Electrons
Hand
Humans
Leukocytosis
Lymphoma*
Magnetic Resonance Imaging
Medulla Oblongata
Methotrexate
Middle Aged
Multiple Sclerosis
Neuromyelitis Optica
Spinal Cord*
Methotrexate
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