Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

Primary central nervous system lymphoma mimicking ventriculitis

Shiro Yamamoto, M.D.1), Seiji Nagano, M.D.2), Sumiya Shibata, M.D.3), Takeharu Kunieda, M.D., Ph.D.3), Yukihiro Imai, M.D., Ph.D.4) and Nobuo Kohara, M.D., Ph.D.1)

1)Department of Neurology, Kobe City Medical Center General Hospital
2)Department of Hematology and Clinical Immunology, Kobe City Medical Center General Hospital
3)Department of Neurosurgery, Kobe City Medical Center General Hospital
4)Department of Pathology, Kobe City Medical Center General Hospital

A 66-year-old man presented with deteriorated bradykinesia, gait disturbance, disorientation, and urinary incontinence for three weeks. Magnetic resonance imaging (MRI) showed dilatation of the ventricles. Cerebrospinal fluid (CSF) examination demonstrated lymphocytic pleocytosis, elevation of protein levels, and decreased of glucose levels. A gadolinium-enhanced MRI revealed lesions in the ventricular wall and choroid plexus, mimicking ventriculitis. No evidence of bacterial, fungal, mycobacterial, or viral infections were observed in the CSF. Flow cytometry of CSF showed predominance of CD20+, λ cells. PCR examination of CSF revealed positive IgH gene rearrangement, suggesting B cell lymphoma. Endoscopic brain biopsy showed diffuse large B cell lymphoma. As the patient had no evidence of lymphoma in the other organs, we made a diagnosed of primary central nervous system lymphoma (PCNSL). A limited intraventricular spread of PCNSL is rare but important as one of differential diagnosis of ventriculitis.
Full Text of this Article in Japanese PDF (9895K)

(CLINICA NEUROL, 53: 831|834, 2013)
key words: primary central nervous system lymphoma (PCNSL), ventriculitis, MRI

(Received: 13-Jan-13)