Persistent lesion hyperintensity on brain diffusion-weighted MRI is an early sign of intravascular lymphoma

Abstract

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.

Numerous Hyperintense Cerebral White Matter Lesions on Diffusion-Weighted Imaging in Intravascular Lymphoma

“…Numerous hyperintense cerebral white matter lesions on DWI are rare in a clinical setting, but have been reported in patients with IVL. 1,2 Compared with the previous patients, 1,2 we could suspect IVL at very early stages based on this characteristic finding. Clinicians should be aware of IVL in patients showing progressive neurological deficits and numerous hyperintense cerebral white matter lesions on DWI.…”

Persisting subacute infarct pattern as early MRI feature of brain intravascular lymphoma

“…Previously, brain lesions showing a subacute infarct pattern (approximately 10–21 days after ischemic stroke onset) characterized by both hyperintensities on diffusion‐weighted images (DWI) and intermediate apparent diffusion coefficient (ADC) values were reported in an IVL patient . Recently, brain lesions showing persistent hyperintensity on DWI as well as various ADC values were reported in an IVL patient . Here, we report a patient with IVL, in whom a subacute brain infarct pattern persisted on MRI for 4 months after onset.…”

“…1 Recently, brain lesions showing persistent hyperintensity on DWI as well as various ADC values were reported in an IVL patient. 2 Here, we report a patient with IVL, in whom a subacute brain infarct pattern persisted on MRI for 4 months after onset.…”