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Reminder of important clinical lesson
CASE REPORT
Persistent lesion hyperintensity on brain diffusion-weighted MRI is an early sign of intravascular lymphoma
  1. Takashi Kageyama1,2,
  2. Haruo Yamanaka1,
  3. Fumihiko Nakamura3,
  4. Toshihiko Suenaga1
  1. 1Department of Neurology, Tenri Hospital, Tenri, Japan
  2. 2Department of Neurology, Tokai Memorial Hospital, Kasugai, Aichi, Japan
  3. 3Department of Hematology, Tenri Hospital, Tenri, Japan
  1. Correspondence to Dr Takashi Kageyama, gohach65{at}yahoo.co.jp

Summary

A 63-year-old man presented with right-sided hemianopia and unsteady gait. Brain MRI revealed multiple hyperintense infarct-like lesions on diffusion-weighted images (DWI). Hyperintensity persisted in some of these lesions even after 6 weeks, although his symptoms were ameliorated then. The patient developed episodic dizziness and a transient event of apraxia at 18 weeks after the first episode. Brain MRI revealed additional hyperintense lesions on DWI, which persisted even after 7 weeks. Eventually, the patient manifested cauda equina syndrome 39 weeks after the first episode. Brain MRI showed the presence of new lesions in addition to the persistent hyperintense lesions on DWI over 21 weeks in the right frontal lobe. Based on laboratory findings and the pathological assessment of bone marrow and random skin biopsies, the patient was diagnosed with intravascular lymphoma (IVL). Persistent hyperintense lesions on DWI of brain MRI may precede the clinical exacerbation of IVL.

  • haematology (incl blood transfusion)
  • neurology
  • neuroimaging
  • neurooncology

https://doi.org/10.1136/bcr-2017-220099

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    Footnotes

    • Contributors TK took care of the patient in this case as primary physician and wrote this article as a corresponding author. HY is a senior resident of the Department of Neurology, who discovered the novel findings on diffusion-weighted images in this case as well as his own unreported case of intravascular lymphoma in our department and made a lot of suggestions for this article. FN worked on the chemotherapy for this patient as a haematologist. TS is the director of the Department of Neurology and supervised this case.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.