Neurocognitive Features Distinguishing Primary Central Nervous System Lymphoma from Other Possible Causes of Rapidly Progressive Dementia

Deutsch, Mariel B.; Mendez, Mario F.

doi:10.1097/wnn.0000000000000048

Cited by 17 publications

(13 citation statements)

References 27 publications

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“…Previous reports of LC have shown several clinical features of this disease, such as subacute progressive dementia, personality changes, unsteady gait and epileptic seizures [ 5 – 7 ]: however, to the best of our knowledge, LC in patients with continuous fever has not been reported to date [ 3 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

A case of lymphomatosis cerebri mimicking inflammatory diseases

et al. 2016

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BackgroundLymphomatosis cerebri (LC) is a rare subtype of primary central nervous system malignant lymphoma. The typical features of this disease exhibited on magnetic resonance imaging (MRI) without contrast enhancement are similar to those observed with diffuse leukoencephalopathy, mimicking white matter disorders such as encephalitis. Clinical features and examination findings that are suggestive of inflammatory diseases may indeed confound the diagnosis of LC.Case presentationA 66-year-old woman with continuous fever over a two-month period developed left hemiparesis despite presenting in an alert state with normal cognitive function. Sampling tests showed autoantibodies in the serum and inflammatory changes in the cerebrospinal fluid. The results from an MRI demonstrated multiple non-enhanced brain lesions in the splenium of the corpus callosum and deep white matter. Single photon emission computed tomography revealed increases in blood flow in the basal ganglia, thalamus and brainstem. No systemic malignancies were found. The patient was suspected of having a diagnosis of nonvasculitic autoimmune inflammatory meningoencephalitis and treated with intravenous methylprednisolone pulse therapy. Her fever transiently dropped to within the normal range. However, she had a sudden seizure and a second MRI exhibited infiltrative lesions gradually extending throughout the whole brain. We performed a brain biopsy, and LC was histologically diagnosed. The patient received whole-brain radiation therapy, which diminished the fever and seizures. The patient died one year after the initial onset of fever.ConclusionsThe present case yields an important consideration that brain neoplasms, especially LC, cannot be ruled out, even in cases with clinical characteristics and examinations consistent with inflammatory diseases. Careful follow-up and histological study are vital for the correct diagnosis of LC.

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Section: Discussionmentioning

confidence: 99%

A case of lymphomatosis cerebri mimicking inflammatory diseases

et al. 2016

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“…179 Data on efficacy of PrEP for transgender individuals are limited. 169,180 Data on drug-drug interactions between PrEP agents and cross-sex hormone therapy and data on PrEP in transgender women do not exist and are needed.…”

Section: Preventionmentioning

confidence: 99%

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

Günthard

Saag

Benson

et al. 2016

JAMA

554

313

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“…Cognitive assessment may sometimes help in distinguishing PCNSL from other nonneoplastic diseases (e.g., Creutzfeldt-Jakob disease, autoimmune encephalitis, paraneoplastic encephalitis, and infectious conditions): in PCNSL patients, memory impairment is more marked than in other rapidly progressive dementias (RPDs), while neurological signs, such as myoclonus and parkinsonism, are very rare [ 92 ].…”

Section: Pcnsl Diagnosis: Role Of Baseline Cognitive Assessmentmentioning

confidence: 99%

Primary CNS Lymphomas: Challenges in Diagnosis and Monitoring

Chiavazza¹,

Pellerino²,

Ferrio³

et al. 2018

BioMed Research International

122

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Primary Central Nervous System Lymphoma (PCNSL) is a rare neoplasm that can involve brain, eye, leptomeninges, and rarely spinal cord. PCNSL lesions most typically enhance homogeneously on T1-weighted magnetic resonance imaging (MRI) and appear T2-hypointense, but high variability in MRI features is commonly encountered. Neurological symptoms and MRI findings may mimic high grade gliomas (HGGs), tumefactive demyelinating lesions (TDLs), or infectious and granulomatous diseases. Advanced MRI techniques (MR diffusion, spectroscopy, and perfusion) and metabolic imaging, such as Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) or amino acid PET (usually employing methionine), may be useful in distinguishing these different entities and monitoring the disease course. Moreover, emerging data suggest a role for cerebrospinal fluid (CSF) markers in predicting prognosis and response to treatments. In this review, we will address the challenges in PCNSL diagnosis, assessment of response to treatments, and evaluation of potential neurotoxicity related to chemotherapy and radiotherapy.

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Neurocognitive Features Distinguishing Primary Central Nervous System Lymphoma from Other Possible Causes of Rapidly Progressive Dementia

Cited by 17 publications

References 27 publications

A case of lymphomatosis cerebri mimicking inflammatory diseases

A case of lymphomatosis cerebri mimicking inflammatory diseases

Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults

Primary CNS Lymphomas: Challenges in Diagnosis and Monitoring

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