Brain Magnetic Resolution Imaging to Diagnose Bing-Neel Syndrome

Abstract

J Korean Neurosurg Soc 46 : [588][589][590][591] 2009 Radiologic findings of Bing-Neel syndrome, which is an extremely uncommon complication resulting from malignant lymphocyte infiltration into the central nervous system (CNS) in patients with Waldenström's macroglobulinemia (WM), have been infrequently reported due to extreme rarity of the case. A 75-year-old man with WM presented at a neurology clinic with progressive gait and memory disturbances, and dysarthria of 2 months duration. Cerebrospinal fluid and serum protein electrophoresis and immunofixation electrophoresis showed IgM kappa-type monoclonal gammopathy. Brain magnetic resonance imaging revealed multifocal, hyperintense lesions on T2 weighted-images. Brain diffusionweighted imaging (DWI) demonstrated hyperintensities in cerebral and cerebellar lesions that appeared isointense on apparent diffusion coefficient maps, which were compatible with vasogenic edema. Although histologic analysis is a confirmative study to prove direct cell infiltration into the brain, brain MRI with DWI may be a good supportive study to diagnose Bing-Neel syndrome.

Guideline for the diagnosis, treatment and response criteria for Bing-Neel syndrome

“…39,40 In diffusion weight imaging (DWI) images, increased signal intensity with elevated or normal (isointense) apparent diffusion coefficient (ADC) values , suggestive of vasogenic edema, can be caused by a malignant cell infiltration in the perivascular spaces damaging this blood-brain barrier ( figure 2D&E). 38,39 In contrast, a restriction of diffusion due to vascular infarcts may be related to HVS and, therefore, DWI can help in the differential diagnosis of BNS.…”

“…In contrast, the tumoral form can be unifocal or multifocal, and is usually located in the deep subcortical hemispheric regions, well-demonstrated in T1 WI and FLAIR sequences as well as in T1 WI after gadolinium administration ( figure 2A&B). 38 Other characteristic findings of leptomeningeal lymphoma can include abnormal contrast enhancement of cranial and spinal nerves as well as thickening and enhancement of the cauda equina ( Figure 2C). Increased parenchymal signal intensity can be identified in T2 and in FLAIR images corresponding either to the tumoral form of the disease or to vasogeneic edema (figure M.C.…”

Intracranial venous sinus thrombosis as unusual presentation of Bing-Neel syndrome: case illustration

“…2,4,5 Neurological complications occur in 25% of these patients 5 with peripheral nerve infiltration or serum hyperviscosity syndrome. 1,3,4 Direct malignant infiltration of the brain is rare and is referred to as Bing-Neel syndrome. 1,3,5 A 42-year-old woman presented with progressive blurred vision, vertigo, and headache.…”

Bing–Neel Syndrome in a Patient with Waldenstrom's Macroglobulinemia: A Challenging Diagnosis in the Face of Normal Brain Imaging

“…In some patients, central neurological symptoms can be caused by direct infiltration of CNS by malignant cells, also known as Bing-Neel syndrome (BNS) [3,4]. Diagnosis of BNS is usually suspected in patients with WM who exhibit CNS symptoms and abnormal brain magnetic resonance imaging (MRI) findings, which can then be confirmed with cerebrospinal fluid (CSF) analysis and/or biopsy [5,6]. We report a case of WM with recurrent neurological symptoms and normal brain MRI where CSF flow cytometry and immunofixation electrophoresis clinched the diagnosis of BNS.…”