IntroductionIntravascular lymphoma is rare, and may present as ischemic stroke. Diagnosis is difficult due to the non-specific presentation and lack of lymphadenopathy, thus leading to frequent instances of autopsy-proven diagnosis. To the best of our knowledge, this is the first report of progressive stroke from intravascular lymphoma diagnosed antemortem by random skin biopsy.Case presentationA 42-year-old Thai man presented to our hospital with progressive multifocal cerebral infarction. Despite taking aspirin (300 mg/day), his neurological symptoms worsened. During admission, he developed an unexplained fever and hypoxemia. Magnetic resonance angiography clearly showed patency of all cerebral arteries including the internal carotid and vertebrobasilar arteries. Echocardiography, an antiphospholipid antibody test, cerebrospinal fluid cytology and a bone marrow study were normal. Other laboratory test results showed an elevated lactate dehydrogenase level, nephrotic range proteinuria (3.91 g/day), hypoalbuminemia (1.9 g/dL), a very low high-density lipoprotein level (7 mg/dL) and hypertriglyceridemia (353 mg/dL). Because of suspected vasculitis, pulse methylprednisolone was given with transiently minimal improvement. A random skin biopsy from both thighs revealed intravascular large B cell lymphoma. Chemotherapy was not given due to our patient having ventilator associated pneumonia. He died 10 days after the definite diagnosis was established.ConclusionOne etiology of stroke is intravascular lymphoma, in which random skin biopsy can be helpful for antemortem diagnosis.

No abstract

Background Neurosyphilis (NS) can lead to acute ischemic stroke (AIS) or transient ischemic attack (TIA). We compared the clinical characteristics and laboratory features among AIS and TIA patients who were syphilis-seronegative (control group) or had latent syphilis (LS) or NS to evaluate their stroke outcome. Methods This prospective cohort study was conducted on patients who had recently suffered AIS or TIA. After serological syphilis screening, clinical and laboratory data were collected, and brain imaging and spinal tap (serologically syphilis-positive patients only) were performed. Stroke outcome was re-evaluated approximately three months later. Results The 344 enrolled patients were divided into three groups: control group (83.7%), LS (13.1%), and NS (3.2%). A multivariate analysis revealed: 1) age of ≥ 70 years, generalized brain atrophy via imaging, and alopecia (adjusted odds ratio [AOR] = 2.635, 2.415, and 13.264, respectively) were significantly associated with LS vs controls; 2) age of ≥ 70 years (AOR = 14.633) was significantly associated with NS vs controls; and 3) the proportion of patients with dysarthria was significantly lower (AOR = 0.154) in the NS group than in the LS group. Regarding the NS patient cerebrospinal fluid (CSF) profile, only 2/11 cases had positive CSF-Venereal Disease Research Laboratory (VDRL) test results; the other nine cases were diagnosed from elevated white blood cell counts or protein levels combined with positive CSF fluorescent treponemal antibody absorption (FTA-ABS) test results. Regarding disability, the initial modified Rankin scale (mRS) score was lower in the control group than in the NS group (p = 0.022). At 3 months post-stroke, the mRS score had significantly decreased in the control (p < 0.001) and LS (p = 0.001) groups. Regarding activities of daily living, the 3-month Barthel Index (BI) score was significantly higher in control patients than in LS (p = 0.030) or NS (p = 0.002) patients. Additionally, the 3-month BI score was significantly increased in the control (p < 0.001) and LS (p = 0.001) groups. Conclusions Because syphilis was detected in many AIS and TIA patients, especially those aged ≥ 70 years, routine serological syphilis screening may be warranted in this population. Patients with syphilitic infection had worse stroke outcomes compared with NS patients.

ObjectiveTo determine cumulative incidence and point prevalence of neuromyelitis optica spectrum disorder (NMOSD), multiple sclerosis (MS), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) in Thailand using population-based data of Chumphon province.BackgroundCNS inflammatory demyelinating diseases (CNSIDDs) have a great interracial heterogeneity. The epidemiology of CNSIDDs in Thailand, a Mainland Southeast Asian country, is unknown.Design/MethodsSearching for CNSIDD patients at a public secondary care hospital in Chumphon from January 2016 to December 2021 was performed using relevant ICD-10-CM codes. All neurology patients were systematically referred to this hospital as it was the only hospital in the province with a neurologist. Diagnoses were individually ascertained by retrospective chart review. Cumulative incidence over 2016-2021, point prevalence on December 31st, 2021, attack rate, mortality rate, and disability-adjusted life years (DALYs) were calculated. Population data were obtained from the National Statistical Office of Thailand. As of December 31st, 2021, the population census of Chumphon was 509,479.ResultsNMOSD was the most prevalent CNSIDD in adult Thai population at 3.33 per 100,000 persons (crude prevalence 2.55). The age-adjusted prevalence of aquaporin-4 antibody-positive NMOSD alone was 3.08 per 100,000 persons. Age-adjusted incidence rate of NMOSD was 1.65 per 100,000 persons/year (crude incidence rate 0.20). Age-adjusted prevalence of MS followed at 0.77 and MOGAD at 0.51 per 100,000 persons (crude prevalence 0.59 and 0.39, respectively). Although most had a fair recovery, disability was worst among NMOSD with a DALY of 3.47 years per 100,000 persons. Mortality and attack rates were highest in NMOSD as well. No increase in incidence or attack rate were observed during the COVID-19 pandemic.ConclusionsCNSIDDs are rare diseases in Thailand. The prevalence is comparable to that of East Asian countries. NMOSD caused the highest DALYs among CNSIDDs.