Ann Clin Neurophysiol.  2019 Jul;21(2):108-112. 10.14253/acn.2019.21.2.108.

Paraneoplastic demyelination in the brain presenting as a clinically occult non-Hodgkin's lymphoma

• Son H
• Choi J
• Kim SU
• Park KS

• KMID: 2454734
• DOI: http://doi.org/10.14253/acn.2019.21.2.108

Abstract

Non-Hodgkin's lymphoma (NHL) may initially present with atypical neurological manifestations, including paraneoplastic neurological syndromes. Herein, we report the case showing an initial manifestation of systemic NHL with paraneoplastic demyelination in the brain that initially mimicked the symptoms of stroke, seizure, and brain tumor. A high index of suspicion and timely diagnostic workup is required to prevent diagnostic delay and commence proper management of the condition. In this situation, a whole-body FDG PET/CT could be useful to screen for occult malignancy.

Keyword

Paraneoplastic syndrome; Occult malignancy; Demyelinating diseases; Non-Hodgkin lymphoma; Diffuse large B-cell lymphoma

MeSH Terms

Brain Neoplasms
Brain*
Demyelinating Diseases*
Lymphoma, Non-Hodgkin*
Neurologic Manifestations
Paraneoplastic Syndromes
Positron-Emission Tomography and Computed Tomography
Seizures
Stroke

Figure

• 

  Fig. 1 Serial follow-up of magnetic resonance imaging (MRI) examinations was performed at (A) 2 weeks and (B) 1 month after symptom onset, as well as (C) 1 year following the initial cycle of chemotherapy. Bilateral involvement of the periventricular, subcortical, frontal, and parietooccipital white matter and the splenium of the corpus callosum on T2-weighted fluid-attenuated inversion recovery images are seen. While the initial MRI lacked contrast enhancement, it appeared on the follow-up MRI performed at 1 month after symptom onset. After chemotherapy, the extent of the lesion markedly decreased and the absence of contrast enhancement was observed.

• 

  Fig. 2 Computed tomography (CT) revealed (A) an osteolytic lesion on T7 and T12 vertebral bodies (yellow arrows). Whole-body (including the brain) 18F-fluorodeoxyglucose positron emission tomography/CT revealed (B) a hypermetabolic lesion in the thoracic spine, bone marrow, and spleen without significant alteration of brain metabolism.

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