“Brain on fire”: A new imaging sign

Epaliyanage, Prasanna; King, Andrew; Hampton, Tim; Gullan, Richard; Ashkan, Keyoumars

doi:10.1016/j.jocn.2014.04.013

Cited by 6 publications

(6 citation statements)

References 7 publications

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“…However, it is known that lymphoma in general, and especially low-grade lymphoma such as MZBCL or FL, is highly responsive to RT alone [20,21,[27][28][29]. This turned out to be true for parenchymal LG-PCNSL in the patient cohort presented here and is corroborated by the literature [11][12][13][14]16,23,30]. In accordance, a SEER database analysis of 4375 PCNSL patients concluded that for patients with indolent PCNSL, radiation monotherapy is an appropriate treatment concept, leading to prolonged survival [31].…”

Section: Discussionsupporting

confidence: 84%

“…Again, the majority (n = 8) were dura-based, with the remaining three cases being located in the parenchyma [12]. Other publications on LG-PCNSL consist of case reports with varying depths of detail (histopathologic description, imaging, treatment) [13][14][15][16][17][18]. Low case numbers and complex differential diagnoses such as CNS involvement in systemic lymphoma, including rare subtypes like Bing-Neel syndrome (BNS, a rare neurologic complication of lymphoplasmocytic lymphoma (LPL)), complicate the process of diagnosis [19].…”

Section: Introductionmentioning

confidence: 99%

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Involved-Site Radiation Therapy Enables Effective Disease Control in Parenchymal Low-Grade Primary Cerebral Lymphoma

Pepper,

Oertel,

Reinartz

et al. 2023

Cancers

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Background: Primary lymphoma of the central nervous system (PCNSL) encompasses a variety of lymphoma subtypes, with the majority being diffuse large B-cell lymphomas, which require aggressive systemic treatment. In contrast, low-grade lymphomas are reported infrequently and are mostly limited to dural manifestations. Very rarely, parenchymal low-grade PCNSL is diagnosed, and the cases documented in the literature show a wide variety of treatment approaches. Methods: We screened all cases of PCNSL treated at our department (a tertiary hematooncology and neurooncology center) in the last 15 years and conducted a comprehensive literature research in the PubMed database. Results: Overall, two cases of low-grade primary parenchymal PCNSL treated with irradiation were identified. The dose prescriptions ranged from 30.6 to 36 Gy for the involved site, with sparing of the hippocampal structures. Both patients had an excellent response to the treatment with a mean follow-up of 20 months. No clinical or radiological signs of treatment toxicity were detected. Conclusions: Our analysis corroborates the results from the literature and demonstrates that parenchymal low-grade PCNSL shows a good response to localized radiation treatment, enabling a favorable outcome while avoiding long-term treatment toxicity.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Involved-Site Radiation Therapy Enables Effective Disease Control in Parenchymal Low-Grade Primary Cerebral Lymphoma

Pepper,

Oertel,

Reinartz

et al. 2023

Cancers

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“…17,28,[46][47][48][49] The second most frequent site of involvement is the glomus of the choroid plexus in the lateral ventricles, a structure with ectodermal origin and devoid of a blood-brain barrier. 22,23,25,27,[49][50][51][52] Twenty-eight cases with parenchymal location of this tumour have been reported so far and are mostly localized in the cortex, 6,39,49,[53][54][55][56] basal ganglia, 26,28,[56][57][58] cerebellopontine angle 20,[59][60][61] and retina. 62 The reported onset symptoms in patients with parenchymal PCNSMZL were facial palsy, hemiparesis and memory disturbance.…”

Section: N Ica L Pr E Se N Tationmentioning

confidence: 99%

“…Intracranial dural localizations mostly involve hemispheric convexities, 40 interhemispheric falx, 41,42 tentorium 6,43–45 and cavernous sinus 17,28,46–49 . The second most frequent site of involvement is the glomus of the choroid plexus in the lateral ventricles, a structure with ectodermal origin and devoid of a blood–brain barrier 22,23,25,27,49–52 . Twenty‐eight cases with parenchymal location of this tumour have been reported so far and are mostly localized in the cortex, 6,39,49,53–56 basal ganglia, 26,28,56–58 cerebellopontine angle 20,59–61 and retina 62 .…”

Section: Clinical Presentationmentioning

confidence: 99%

Primary central nervous system marginal zone lymphoma

Flospergher,

Marino,

Calimeri

et al. 2023

Br J Haematol

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SummaryMarginal zone lymphoma (MZL) is the most common indolent lymphoma primarily arising in the central nervous system (CNS). To date, 207 cases of primary CNS MZL (PCNSMZL) were published, mostly as single case reports or small case series. It most commonly presents as extra‐axial dural‐based masses, more frequently in middle‐aged women, displaying an insidious onset, with a long history of symptoms preceding the diagnosis. PCNSMZL can be radiographically mistaken for meningioma. PCNSMZL consists of CD20+, CD3− small B lymphocytes with varying degrees of plasmacytic differentiation and low proliferation index. Trisomy 3, but not MALT1 or IgH translocation, is a common genetic abnormality. Other recurrent genetic abnormalities involve TNFAIP3 and NOTCH2. Ethiopathogenesis was poorly investigated. Due to its rarity, standard of care remains to be defined; it exhibits an excellent prognosis after varied treatments, such as surgery, radiotherapy, chemotherapy or their combinations. Nevertheless, each treatment should be considered after an accurate analysis of overtreatment risk. Short follow‐up is a major limitation in reported PCNSMZL cases, which restrains our knowledge on long‐term results and iatrogenic sequels. This review was focussed on presentation, differential diagnoses, pathological findings, treatment options and clinical outcomes of PCNSMZL; recommendations for best clinical practice are provided.

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“…The common neuroimaging features of meningeal metastases include arachnoidal, subependymal, dural or cranial nerve enhancement; superficial cerebral lesions; and communicating hydrocephalus [5]. Parenchymal metastases from non-Hodgkin lymphoma often appear as single or multiple enhancing lesions and can be accompanied by leptomeningeal metastases or, sporadically, with a pattern of miliary enhancement characterized by multiple CNS punctate and curvilinear lesions [4,6,7]. Cytology of the CSF usually shows malignant cells [8].…”

Section: Cns Lymphomamentioning

confidence: 99%

Brain miliary enhancement

et al. 2020

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Purpose Miliary enhancement refers to the presence of multiple small, monomorphic, enhancing foci on T1-weighted postcontrast MRI images. In the absence of a clear clinical presentation, a broad differential diagnosis may result in invasive procedures and possibly brain biopsy for diagnostic purposes. Methods An extensive review of the literature is provided for diseases that may present with miliary enhancement on T1weighted brain MR images. Additional disease-specific findings, both clinical and radiological, are summarized and categorized by the presence or absence of perivascular space involvement. Results Miliary pattern of enhancement may be due to a variety of underlying causes, including inflammatory, infectious, nutritional or neoplastic processes. The recognition of disease spread along the perivascular spaces in addition to the detection or exclusion of disease-specific features on MRI images, such as leptomeningeal enhancement, presence of haemorrhagic lesions, spinal cord involvement and specific localisation or systemic involvement, allows to narrow the potential differential diagnoses. Conclusion A systematic approach to disease-specific findings from both clinical and radiological perspectives might facilitate diagnostic work-up, and recognition of disease spread along the perivascular spaces may help narrowing down differential diagnoses and may help to minimize the use of invasive diagnostic procedures.

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“Brain on fire”: A new imaging sign

Cited by 6 publications

References 7 publications

Involved-Site Radiation Therapy Enables Effective Disease Control in Parenchymal Low-Grade Primary Cerebral Lymphoma

Involved-Site Radiation Therapy Enables Effective Disease Control in Parenchymal Low-Grade Primary Cerebral Lymphoma

Primary central nervous system marginal zone lymphoma

Brain miliary enhancement

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