Primary central nervous system lymphoma: an unusual presentation.

نویسندگان

  • J M Heckmann
  • S O'Ryan
  • S Candy
چکیده

A 42-year-old woman presented with isolated right third nerve palsy and preceding lethargy. A previous head injury had required craniotomy, orbital reconstruction and medication to control the subsequent epilepsy. Apart from the pupillarysparing third nerve palsy, the general and neurological examinations were normal. Magnetic resonance imaging (MRI) revealed post-traumatic right frontal cortical gliosis consistent with the previous trauma (Fig. 1). The remaining T2-weighted and FLAIR images were normal and did not demonstrate a cause of the third nerve palsy. Cerebrospinal fluid (CSF) investigations demonstrated a lymphocytic meningitic picture with 100 lymphocytes/μl, no polymorphs, protein 1.08 g/l (normal ≤0.45 g/l), glucose 2.7 mmol/l (blood glucose 6.1 mmol/l) and 201 erythrocytes/μl, and were negative for tuberculosis, syphilis and cryptococcus. Three weeks later, she was referred for workup of the isolated right third nerve palsy, the unexplained lymphocytic meningitis and increasing drowsiness. A second CSF examination showed 14 lymphocytes/μl, protein 1.4 g/l, glucose 2.5 mmol/l, and an unhelpful cytological examination. A week later, she developed bilateral third nerve palsies with dilated pupils, and increasing drowsiness. An urgent computed tomography (CT) scan demonstrated extensive enhancing tissue in the periventricular and subependymal brain parenchyma (Fig. 2) extending into the midbrain area. A brain CT angiogram was normal. An endoscopic brain biopsy histological examination confirmed large B-cell lymphoma. High-dose methotrexate was commenced but the patient deteriorated and died 5 weeks after presentation.

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عنوان ژورنال:
  • South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde

دوره 98 11  شماره 

صفحات  -

تاریخ انتشار 2008