Primary central nervous system lymphoma presenting with Parkinsonism as an initial manifestation: A case report and literature review

Abstract

Primary central nervous system lymphoma (PCNSL) is a rare intracranial neoplasm in older adults. Tumor-associated parkinsonism (TAP) in PCNSL is extremely rare, and its clinical features are unclear. The present report describes the case of a 75-year-old man who presented with parkinsonism due to multiple hyperintense lesions in the thalamus and periventricular white matter as visualized by magnetic resonance imaging (MRI). Due to the rapid progression of parkinsonism and lesion enlargement, the patient underwent stereotaxic biopsy. Subsequently, his condition was diagnosed as TAP in PCNSL at 2 months after onset. The patient completely recovered after treatment and experienced no recurrence of TAP for 8 months. Although it is difficult to distinguish TAP from vascular parkinsonism (VP) at initial consultation, the early diagnosis of PCNSL is important for improving prognosis. In the case of rapidly progressing parkinsonism, one should suspect the possibility of TAP associated with early-stage PCNSL. Early treatment improves the chances of remission and decreases the possibility of recurrence.

Tumoral parkinsonism—Parkinsonism secondary to brain tumors, paraneoplastic syndromes, intracranial malformations, or oncological intervention, and the effect of dopaminergic treatment

“…Primary CNS lymphoma is a rare disease, primarily affecting older people, and secondary parkinsonism due to CNS lymphoma is extraordinarily rare (Okano et al., 2021 ). Okano et al.…”

“…Primary CNS lymphoma is a rare disease, primarily affecting older people, and secondary parkinsonism due to CNS lymphoma is extraordinarily rare (Okano et al, 2021). Okano et al described a 75-year-old male who had several lesions in the thalamic and surrounding white matter regions, exhibiting classic signs of parkinsonism.…”

Primary central nervous system lymphoma of the third ventricle with intra‑tumoral hemorrhage: A case report and literature review

“…All cases had a good prognosis, which may be related to the fact that third-ventricle PCNSL presents with hydrocephalus at an early stage, which is easily detected. The possibility of improved prognosis with early therapeutic intervention (before tumor infiltration into the brain) has been reported, and clinicians should consider PCNSL in the differential diagnosis of third-ventricle tumors ( 2 ).…”

“…Primary central nervous system lymphoma (PCNSL) is a highly aggressive non-Hodgkin lymphoma confined to the central nervous system that accounts for merely 0.7–0.9% of all lymphomas, and 0.3–1.5% of all intracranial lymphomas ( 1 ). Although PCNSL is a rare intracranial tumor, its incidence has significantly increased in patients over 60 years of age in the past two decades ( 2 ). Immunodeficiency, HIV infection, and the administration of immunosuppressive agents following organ transplantation are risk factors for developing PCNSL; however, there is also an increase in the incidence of this tumor in immunocompetent individuals ( 1 , 2 ).…”

“…Although PCNSL is a rare intracranial tumor, its incidence has significantly increased in patients over 60 years of age in the past two decades ( 2 ). Immunodeficiency, HIV infection, and the administration of immunosuppressive agents following organ transplantation are risk factors for developing PCNSL; however, there is also an increase in the incidence of this tumor in immunocompetent individuals ( 1 , 2 ). PCNSL classified as haematolymphoid tumors involving the central nervous system (CNS), according to the World Health Organization Classification of tumors of the CNS.…”