Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

Misleading cerebral arterial wall gadolinium-enhancement in malignant lymphoma

Hiroyasu Inoue, M.D.1)2), Keita Sakurai, M.D.3), Yuuya Kanou, M.D.1), Kentaro Yamada, M.D.2) and Hiroyuki Yuasa, M.D.1)

1)Department of Neurology, Tosei General Hospital
2)Department of Neurology, Nagoya City East Medical Center
3)Department of Diagnostic Radiology, Tokyo Metropolitan Medical Center of Gerontology

A previously healthy, 77-year-old woman presented with gradual cognitive decline and acute gait imbalance. On admission, despite no obvious paralysis, she tilted to the right. Her Mini-Mental State Examination score was slightly low (23/30). Gadolinium-enhanced, high-resolution T1-weighted MRI showed abnormal arterial wall enhancement at the bilateral middle cerebral and right internal carotid arteries. The combination of arterial and parenchymal enhancement limited to the central nervous system (CNS), normal laboratory data including soluble interleukin-2 receptor, and random skin and bone-marrow biopsies was suggested of primary angiitis of the CNS (PACNS). However, a biopsy specimen from the right insula showed CD20-positive lymphoma cells indicative of diffuse large B-cell lymphoma. After receiving chemotherapy, above-mentioned abnormal findings were significantly improved. Considering the increasing clinical application of high resolution MRI, there is a risk that patients may receive a presumptive diagnosis of PACNS and immunosuppressive treatment without biopsy confirmation. It should be noted that a combination of abnormal arterial wall and linear parenchymal enhancement similar to that found for PACNS on high-resolution MRI may occur in patients with primary central nervous system lymphoma.
Full Text of this Article in Japanese PDF (730K)

(CLINICA NEUROL, 58: 456|459, 2018)
key words: primary central nervous system lymphoma, primary angiitis of the central nervous system, high resolution MRI, arterial wall enhancement, brain biopsy

(Received: 5-Apr-18)