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KMID : 1201420190120010055
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Journal of Neurocritical Care
2019 Volume.12 No. 1 p.55 ~ p.63
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Primary central nervous system lymphoma with intramedullary spinal cord involvement mimicking inflammatory demyelinating disease
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Kim Hyun-Soo
Nam Tai-Seung
Levy Michael
Lee Kyung-Hwa
Kim Ja-Hae
Lee Seung-Jin
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Abstract
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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 18F-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.
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KEYWORD
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Primary central nervous system lymphoma, Neuromyelitis optica, Multiple sclerosis, Spinal cord, Magnetic resonance imaging
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