Recurrent cerebrovascular accidents caused by intravascular lymphoma in a dog

Abstract

An eight-year-old, neutered male labrador was presented with recent recurrent vestibular episodes. MRI was consistent with multiple lacunar ischaemic infarcts in the thalamus and medulla oblongata. The imaging diagnosis was supported by a markedly elevated D-dimer concentration. Despite a comprehensive diagnostic workup (including fine needle cytology of cutaneous and subcutaneous nodules, complete bloodwork, urinalysis, thoracic and abdominal imaging, cerebrospinal fluid analysis, serial blood pressure measurements, echocardiography, electrocardiography and brainstem auditory evoked response testing), no underlying cause was found. After a partial response to 2 mg/kg clopidogrel once a day and 1 mg/kg prednisolone once a day, the dog acutely deteriorated and repeated MRI of the brain revealed an intra-axial haemorrhagic mass. Euthanasia was elected and postmortem examination revealed the presence of an intravascular null-cell lymphoma, exclusively in the central nervous system. Intravascular lymphoma is rare, difficult to diagnose ante-mortem and reports in veterinary literature are few.

MRI ischemic and hemorrhagic lesions in arterial and venous territories characterize central nervous system intravascular lymphoma in dogs

“…In the present study, eight dogs had immunohistochemistry performed, and interestingly seven cases exhibited a T‐cell immunophenotype, and one was negative for B‐ and T‐cell markers, while no B‐cell immunophenotype was recorded. In previous veterinary case reports, all three phenotypes have been described 5,7,16–18,40 …”

“…1,3,8,9,13 Only five case reports describing the MRI findings in dogs with CNS IVL have been published in the veterinary literature, and a few additional cases are included in other publications. 5,[16][17][18][19][20][21][22] Multifocal T1-weighted (T1w) iso-to hyperintense, T2w and T2w-fluidattenuated inversion recovery (FLAIR) hyperintense lesions, and variable parenchymal and meningeal enhancement are reported. 5,[16][17][18][19] Areas of signal void on gradient echo (GRE) images and abnormally restricted diffusion on diffusion-weighted imaging (DWI) are also described, displaying varying combinations of infarctive, hemorrhagic, and neoplastic features.…”

Intravascular lymphoma in a dog: case report

“…The lesions caused in the different organs are associated with vascular occlusions caused by the tumor resulting in thrombi and infarcts (10,18). Macroscopic lesions are uncommon, but when present, involve the central nervous system (12).…”

Suspected spontaneous early hemorrhagic transformation of multiple ischemic strokes secondary to primary splenic torsion in a German Shepherd dog

“…These lesions were suspected to represent hemorrhagic stroke (HS) in the distribution of the right rostral cerebellar artery and perforating arteries, respectively. The differential diagnosis for multiple IS includes hypercoagulable states, systemic hypertension, neoplasia, heartworm disease, ceroid amyloid angiopathy, and septic disease 1‐8 . The differential diagnosis for multiple nontraumatic intraparenchymal HS includes primary causes, such as systemic hypertension and ceroid amyloid angiopathy, and secondary causes, such as vascular malformations, intracranial neoplasms, endoparasitism ( Angiostrongylus vasorum ), and coagulopathy 3,5,7,9,10 .…”

“…The differential diagnosis for multiple IS includes hypercoagulable states, systemic hypertension, neoplasia, heartworm disease, ceroid amyloid angiopathy, and septic disease. [1][2][3][4][5][6][7][8] The differential diagnosis for multiple nontraumatic intraparenchymal HS includes primary causes, such as systemic hypertension and ceroid amyloid angiopathy, and secondary causes, such as vascular malformations, intracranial neoplasms, endoparasitism (Angiostrongylus vasorum), and coagulopathy. 3,5,7,9,10 The right temporal muscle showed a focal area of T2W hyperintensity and increased contrast enhancement consistent with a contusion secondary to GTCS or, less likely, focal inflammation or necrosis.…”