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Diffusely Infiltrating Central Nervous System Lymphoma Involving the Brainstem in an Immune-Competent Patient

Diffusely Infiltrating Central Nervous System Lymphoma Involving the Brainstem in an... Clinical Review & Education Images in Neurology Diffusely Infiltrating Central Nervous System Lymphoma Involving the Brainstem in an Immune-Competent Patient Khalid Alsherbini, MD; Brad Beinlich, MD; M. Shahriar Salamat, MS, MD, PhD A 49-year-old right-handed woman presented with a 3-week his- showed moderate clinical improvement initially and there was sig- tory of progressive ataxia, dysarthria, right hemiparesis, cognitive nificant reduction in edema on magnetic resonance imaging but per- decline, and headache. Infectious, inflammatory, neoplastic, and sistentperivascularcurvilinearenhancement(Figure1 andFigure2). paraneoplastic workup results were unremarkable. The ophthalmo- With subsequent clinical progression while the patient was taking logicevaluationfindingswereunremarkableforinflammatoryorneo- steroids, a cerebellar biopsy was performed and revealed primary plastic involvement. Repeated lumbar puncture findings revealed large B-cell non-Hodgkin lymphoma (Figure 3). The patient under- mild lymphocytic pleocytosis with mildly elevated proteins. Cere- went 4 cycles of high-dose methotrexate, rituximab, and temozo- brospinal fluid cytology and flow cytometry results were negative. lomide. Following the first 2 cycles, she had a complete resolution Magnetic resonance imaging of the brain showed a diffusely en- of her speech symptoms and significant improvement of her right- hancing lesion typical for CLIPPERS (chronic lymphocytic inflam- sided weakness. Unfortunately, her treatment was complicated by mation with pontine perivascular enhancement responsive to http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA Neurology American Medical Association

Diffusely Infiltrating Central Nervous System Lymphoma Involving the Brainstem in an Immune-Competent Patient

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Publisher
American Medical Association
Copyright
Copyright 2014 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
ISSN
2168-6149
eISSN
2168-6157
DOI
10.1001/jamaneurol.2013.1578
pmid
24217110
Publisher site
See Article on Publisher Site

Abstract

Clinical Review & Education Images in Neurology Diffusely Infiltrating Central Nervous System Lymphoma Involving the Brainstem in an Immune-Competent Patient Khalid Alsherbini, MD; Brad Beinlich, MD; M. Shahriar Salamat, MS, MD, PhD A 49-year-old right-handed woman presented with a 3-week his- showed moderate clinical improvement initially and there was sig- tory of progressive ataxia, dysarthria, right hemiparesis, cognitive nificant reduction in edema on magnetic resonance imaging but per- decline, and headache. Infectious, inflammatory, neoplastic, and sistentperivascularcurvilinearenhancement(Figure1 andFigure2). paraneoplastic workup results were unremarkable. The ophthalmo- With subsequent clinical progression while the patient was taking logicevaluationfindingswereunremarkableforinflammatoryorneo- steroids, a cerebellar biopsy was performed and revealed primary plastic involvement. Repeated lumbar puncture findings revealed large B-cell non-Hodgkin lymphoma (Figure 3). The patient under- mild lymphocytic pleocytosis with mildly elevated proteins. Cere- went 4 cycles of high-dose methotrexate, rituximab, and temozo- brospinal fluid cytology and flow cytometry results were negative. lomide. Following the first 2 cycles, she had a complete resolution Magnetic resonance imaging of the brain showed a diffusely en- of her speech symptoms and significant improvement of her right- hancing lesion typical for CLIPPERS (chronic lymphocytic inflam- sided weakness. Unfortunately, her treatment was complicated by mation with pontine perivascular enhancement responsive to

Journal

JAMA NeurologyAmerican Medical Association

Published: Jan 1, 2014

References