A Case of Intravascular Malignant Lymphomatosis Presenting as Cerebral Infarction Takeshi SATOW 1,4 , Sachio NABESHIMA 1 , Naohiro YAMAZOE 1 , Fumiaki ISAKA 1 , Yasushi MOTOYAMA 1 , Kazushi HIGUCHI 1 , Yuki KAWAMURA 2 , Yasuaki HAYASHINO 3 1Department of Neurosurgery, Tenri Hospital 2Department of Neurology, Tenri Hospital 3Department of Hematology, Tenri Hospital 4Department of Neurosurgery, Kyoto University School of Medicine Keyword: intravascular malignant lymphomatosis , cerebral infarction , dementia , brain biopsy pp.1023-1028
Published Date 2000/11/10
DOI https://doi.org/10.11477/mf.1436901974
  • Abstract
  • Look Inside

A case of intravascular malignant lymphomatosis (IML) presenting as progressive cerebral infarction is reported. A 62-year-old previously healthy male developed progressive dementia. MRI of the brain at the nearest hospital revealed multiple infarcts with unknown etiology. His level of consciousness deteriorated rapidly, and then he was transferred to our hospital for further evaluation. High grade fever, raised serum C reactive protein (CRP), and raised lymphoma markers (serum LDH and soluble IL-2 receptor (sIL-2R)) were observed. Repeated brain MRI disclosed progression of multifocal cerebral infarctions. We considered IML most likely, and we performed muscle biopsy. However muscle biopsy didn't demonstrate any proli-feration of neoplastic cells of lymphoid origin within small vessels. Thereafter IML was diagnosed by brain biopsy. The patient underwent chemotherapy, but died of pneumonia due to severe myelosuppression. IML is a rare disease but most commonly shows neurological symptomatology as its clinical manifesta-tion. Dementia is the most common neurological symptom, and progressive multiple infarction is the most common of the MRI findings. Rapidly progressive dementia associated with multiple infarction, when ele-vated CRP, LDH and sIL-2R are observed in the laboratory data, is suggestive of IML.

Copyright © 2000, Igaku-Shoin Ltd. All rights reserved.


電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院