CPM can develop in the setting of hyperosmolar hyperglycemia without abnormalities of sodium homeostasis. This supports the theory that the pathogenesis of CPM is dependent on a relatively hypertonic insult, which may occur independently of sodium abnormalities. CPM can present as isolated gait ataxia. Clinical manifestations of the disorder may show significant improvement despite a dramatic initial presentation.

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A 60-year-old man with T-cell lymphoma post chemotherapy presented with progressive left greater than right lower extremity weakness and allodynia. Fluorodeoxyglucose-PET was consistent with neoplastic infiltration of multiple lumbosacral roots and sciatic nerves (figure). Spinal fluid cytology showed malignant T-cells, supporting the diagnosis of neurolymphomatosis. Resolution of the imaging abnormalities and clinical improvement occurred following high dose intrathecal methotrexate.Neurolymphomatosis is an especially rare complication of T-cell malignancies. 1 If spinal fluid cytology cannot make the diagnosis, as in this case, radiographic directed proximal nerve and root biopsy may be helpful.

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