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Severe ataxia uncovered Hodgkin’s lymphoma: do not forget CT neck when looking for covert malignancy
  1. Naim Izet Kajtazi1,
  2. Ehtesham Khalid2,
  3. Juman Al Ghamdi3,
  4. Ahmad Abulaban4,5 and
  5. Majed H AlHameed1
  1. 1Neurology, King Fahad Medical City, Riyadh, Saudi Arabia
  2. 2Department of Neurology, Ideal Medicare Clinic, Multan, Punjab, Pakistan
  3. 3Medical Imaging Administration, Intervention Neuroradiology, King Fahad Medical City, Riyadh, Saudi Arabia
  4. 4Neurology, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
  5. 5King Abdullah International Medical Research Center, Riyadh, Riyadh, Saudi Arabia
  1. Correspondence to Dr Naim Izet Kajtazi; nkajtazi{at}gmail.com

Abstract

A 53-year-old woman without medical problems presented with 5-month history of dizziness, difficulty speaking, severe ataxia, which worsened a day before admission to inability to stand unsupported. An extensive workup was initiated to find the cause of ataxia. The laboratory investigations and imaging of the brain and whole spine revealed no lesions. She was found to have autoimmune thyroiditis, positive coeliac disease antibodies without clinical features and vitamin D deficiency. No intravenous steroids or immunosuppressive therapy was given. Cerebrospinal fluid showed lymphocytic pleocytosis. The workup for the cause of severe ataxia revealed an oropharyngeal lesion with cervical lymph nodes, and the biopsy showed classical Hodgkin’s lymphoma of mixed cellularity. She was treated with chemotherapy followed by radiation therapy and made a remarkable recovery, and currently, she is in remission without distant metastases, 5 years after the initial diagnosis. Her neurological status improved, and she remained with mild ataxia.

  • movement disorders (other than Parkinson's)
  • infection (neurology)
  • headache (including migraines)
  • neuroimaging
  • haematology (incl blood transfusion)

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Footnotes

  • Contributors NIK has contributed with case report design, planning, scanned files review, writing patient history, investigations, treatment, follow-up, interpretation of data, the intellectual content of the manuscript, coordinated work with other co-authors, obtained patient consent, and submission on behalf of all of them. EK has contributed with interpretation of data, literature review, discussion part, and intellectual content of the manuscript. JAG has contributed to the selection of good quality radiology images from PACS with annotations. AA has contributed with interpretation of data, literature review, discussion part, the intellectual content of the manuscript. MHA has contributed to the intellectual content of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

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