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Low-grade non-Hodgkin B-cell lymphoma was found during the evaluation of 3 aged patients with predominantly sensory neuropathy of mild to moderate severity. Presenting manifestations were sensory ataxia and right ulnar mono-neuropathy in a 75-year-old man, and painful dysesthesias of the legs in two 78-year-old women. A neurophysiological study showed mainly axonopathic alterations. M-protein was present in all cases (Ig-K in two, triclonal gammopathy IgG(K)/IgM(K)/IgM-A, in one). The male patient had IgM antisulfatide antibody in high titer, whereas the other 2 patients had cryoglobulinemia (type II and type III, respectively). Our report emphasizes the occurrence of mild polyneuropathy as presenting manifestation of low-grade non-Hodgkin lymphoma, different from the clinicopathological entity of neurolymphomatosis, in which severe nerve damage occurs in association with manifest lymphoma, related to nerve infiltration by lymphomatous cells. Alternative pathogenetic mechanisms, such as antibody-mediated nerve damage, or vasa nervorum changes caused by cryoglobulin, may be implicated in our cases. Non-Hodgkin lymphoma should be considered in the diagnostic evaluation of polyneuropathy of unknown cause, especially in patients with paraproteinemia and/or cryoglobulinemia.

A patient undergoing chemotherapy for multiple myeloma had a sudden onset of heart failure. Cardiac magnetic resonance was performed after echocardiography to rule out myocardial late enhancement, which was not detected. Interestingly, the inversion time of the T1-weighted inversion recovery late enhancement sequence needed to be significantly increased (from the usual 250-300 to 490 ms) to obtain diagnostic images. This report presents the clinical case of this patient, and discusses potential implications.

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Italian 40-year-old right-handed woman, with late, consecutive, and balanced bilingualism (English), presented with comprehension aphasia of ischemic etiology (figure, A) in the primary language, but not in the second one. After a 3-month logopedic rehabilitation, speech-language improved dramatically. Later, fMRI was performed with task of verbal fluency-verb generation 1 on both languages. The Italian task showed activation of left Broca and Wernicke areas (figure, B and C), while prominent activation was evident on right superior temporal gyrus in the English task. Broca area was represented bilaterally (figure, D-F). The fMRI provides insights into language organization in bilingual patients. 2 Study funding No targeted funding reported.