Fulminant intravascular lymphomatosis mimicking acute haemorrhagic leukoencephalopathy

Marino, Daniela; Sicurelli, Francesco; Cerase, Alfonso; Tripodi, Sergio; Cintorino, Marcella; Lazzi, Stefano; Federico, Antonio

doi:10.1016/j.jns.2012.05.043

Cited by 10 publications

(7 citation statements)

References 18 publications

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“…[19,20] The utility of fluorodeoxyglucose positron emission tomography in its early detection remains controversial. [21,22] An organ biopsy is mandatory for the diagnosis of IVLBCL.…”

Section: Discussionmentioning

confidence: 99%

A 58-year-old lady with progressive neurological syndrome: Presence of an intravascular lymphoma

Jethwani¹,

Yadav²,

Chickabasaviah³

2015

Neurol India

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“…[19,20] The utility of fluorodeoxyglucose positron emission tomography in its early detection remains controversial. [21,22] An organ biopsy is mandatory for the diagnosis of IVLBCL.…”

Section: Discussionmentioning

confidence: 99%

A 58-year-old lady with progressive neurological syndrome: Presence of an intravascular lymphoma

Jethwani¹,

Yadav²,

Chickabasaviah³

2015

Neurol India

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“…[42]. CSF cytology was tested in five cases, among whom only one case cytology showed several malignant lymphoblastic cells [28], while others were negative for malignant cells [16,21,29,36,45]. CSF clonal immunoglobulin heavy chain (IgH) gene rearrangement was noted in two cases that are diagnostic of CNS Bcell lymphoma [11].…”

Section: Clinical Features Serum and Csf Findings Imaging Eeg And Bio...mentioning

confidence: 99%

Intravascular Lymphoma-Associated Stroke: A Systematic Review of Case Studies

Bhagat,

Shahab,

Karki

et al. 2023

Cureus

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Intravascular lymphoma (IVL) is an aggressive systemic large B-cell lymphoma that is a rare cause of stroke. The clinical characteristics of stroke associated with IVL remain underexplored, contributing to diagnostic complexities and a high mortality rate. This study endeavors to elucidate the salient clinical and investigative features of stroke linked to this condition. A systematic review was performed using the PubMed database from the incident to August 2023 including search categories for IVL and stroke. All studies, excluding review articles, were included in this study. There were 58 cases with a confirmed diagnosis of IVL associated with stroke, with a mean age of 62.9 ± 9.6 years (female 50%). Classical lateralizing stroke symptoms were noted in only 69% of cases. Other clinical syndromes included altered sensorium (31%), rapidly progressive cognitive impairment (23%), seizures (22%), and gait disturbances (19%). Common hematological abnormalities included elevated lactate dehydrogenase (LDH, 97%), erythrocyte sedimentation rate (ESR, 79%), C-reactive protein (CRP, 61%), interleukin-2, microglobulins, and cerebrospinal fluid (CSF) protein. CSF flow cytometry was not diagnostic, and cytology was mostly negative. The dynamic pattern for DWI/T2 lesions was predominant and primarily located in the subcortical regions. Diffuse background slowing (64%) was a major finding in the electroencephalogram. Seventy-one percent of cases died (n=45) mostly due to delayed diagnosis. Only 31% were treated with first-line R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, prednisone) chemotherapy, among whom 25% died. This study suggests that IVL-associated strokes carry a high mortality rate, largely due to challenges in timely diagnosis and therapy. Unlike classical stroke syndrome, key indicators to aid in early diagnosis include a clinical syndrome of multiple non-lateralizing neurological symptoms, dynamic MRI DWI/T2-lesions primarily located in subcortical regions, elevated serum LDH, ESR, CRP, interleukins, microglobulin, CSF protein, and CSF polymerase chain reaction analysis, apart from tissue examination. Larger studies should be performed to establish diagnostic and predictive scores.

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“…At MR imaging, IVL may mimic AHLE. The characteristic allowing differentiation is that IVL involves multiple areas of restricted diffusion without gadolinium enhancement and a small area of gadolinium enhancement (42).…”

Section: Neoplasms Related To Medullary Veinsmentioning

confidence: 99%

Structure of the Medullary Veins of the Cerebral Hemisphere and Related Disorders

Taoka¹,

Fukusumi²,

Miyasaka³

et al. 2017

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Deep medullary veins drain into subependymal veins with four convergence zones and show parallel distribution patterns adjacent to the body or inferior horn and a radial pattern in the frontal horn or trigon of the lateral ventricle. As white matter imaging develops such as diffusion tensor imaging or susceptibility-weighted imaging, requirements for understanding of white matter structures are increasing, not only for understanding of neuronal tracts but also for that of other structures including the fine anatomy of white matter vessels. Some disorders are related to deep medullary veins and show characteristic distributions of the lesions indicating the relationship to the medullary veins. When lesions show a parallel or radial distribution pattern in the certebral deep white matter, disorders related to deep medullary veins should be considered for differential diagnosis. In this review, we discuss disorders related to deep medullary veins, including (a) anomalies of the medullary veins, (b) hemorrhagic disorders related to the medullary veins (diffuse vascular injury due to high-energy trauma, deep medullary vein engorgement/thrombosis in neonates), (c) inflammatory changes that spread along the medullary veins, (d) neoplasms within the medullary veins, and (e) metabolic changes that lead to altered visualization of medullary veins. Understanding the anatomic structure of medullary veins in the cerebral hemisphere and becoming familiar with disorders in which the medullary veins play a major role in disease development may be helpful in the interpretation of brain images. RSNA, 2017.

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Fulminant intravascular lymphomatosis mimicking acute haemorrhagic leukoencephalopathy

Cited by 10 publications

References 18 publications

A 58-year-old lady with progressive neurological syndrome: Presence of an intravascular lymphoma

A 58-year-old lady with progressive neurological syndrome: Presence of an intravascular lymphoma

Intravascular Lymphoma-Associated Stroke: A Systematic Review of Case Studies

Structure of the Medullary Veins of the Cerebral Hemisphere and Related Disorders

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