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Misleading cerebral arterial wall gadolinium-enhancement in malignant lymphoma
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- Inoue Hiroyasu
- Department of Neurology, Tosei General Hospital Department of Neurology, Nagoya City East Medical Center
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- Sakurai Keita
- Department of Diagnostic Radiology, Tokyo Metropolitan Medical Center of Gerontology
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- Kanou Yuuya
- Department of Neurology, Tosei General Hospital
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- Yamada Kentaro
- Department of Neurology, Nagoya City East Medical Center
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- Yuasa Hiroyuki
- Department of Neurology, Tosei General Hospital
Bibliographic Information
- Other Title
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- 高解像度MRIで原発性中枢神経系血管炎との鑑別が問題となった中枢神経原発悪性リンパ腫の1例
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Description
<p>A previously healthy, 77-year-old woman presented with gradual cognitive decline and acute gait imbalance. On admission, despite no obvious paralysis, she tilted to the right. Her Mini-Mental State Examination score was slightly low (23/30). Gadolinium-enhanced, high-resolution T1-weighted MRI showed abnormal arterial wall enhancement at the bilateral middle cerebral and right internal carotid arteries. The combination of arterial and parenchymal enhancement limited to the central nervous system (CNS), normal laboratory data including soluble interleukin-2 receptor, and random skin and bone-marrow biopsies was suggested of primary angiitis of the CNS (PACNS). However, a biopsy specimen from the right insula showed CD20-positive lymphoma cells indicative of diffuse large B-cell lymphoma. After receiving chemotherapy, above-mentioned abnormal findings were significantly improved. Considering the increasing clinical application of high resolution MRI, there is a risk that patients may receive a presumptive diagnosis of PACNS and immunosuppressive treatment without biopsy confirmation. It should be noted that a combination of abnormal arterial wall and linear parenchymal enhancement similar to that found for PACNS on high-resolution MRI may occur in patients with primary central nervous system lymphoma.</p>
Journal
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- Rinsho Shinkeigaku
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Rinsho Shinkeigaku 58 (7), 456-459, 2018
Societas Neurologica Japonica
