Kageyama Takashi, Yamanaka Haruo, Nakamura Fumihiko, Suenaga Toshihiko
Department of Neurology, Tenri Hospital, Tenri, Japan.
Department of Neurology, Tokai Memorial Hospital, Kasugai, Aichi, Japan.
BMJ Case Rep. 2017 Jun 8;2017:bcr-2017-220099. doi: 10.1136/bcr-2017-220099.
A 63-year-old man presented with right-sided hemianopia and unsteady gait. Brain MRI revealed multiple hyperintense infarct-like lesions on diffusion-weighted images (DWI). Hyperintensity persisted in some of these lesions even after 6 weeks, although his symptoms were ameliorated then. The patient developed episodic dizziness and a transient event of apraxia at 18 weeks after the first episode. Brain MRI revealed additional hyperintense lesions on DWI, which persisted even after 7 weeks. Eventually, the patient manifested cauda equina syndrome 39 weeks after the first episode. Brain MRI showed the presence of new lesions in addition to the persistent hyperintense lesions on DWI over 21 weeks in the right frontal lobe. Based on laboratory findings and the pathological assessment of bone marrow and random skin biopsies, the patient was diagnosed with intravascular lymphoma (IVL). Persistent hyperintense lesions on DWI of brain MRI may precede the clinical exacerbation of IVL.
一名63岁男性出现右侧偏盲和步态不稳。脑部磁共振成像（MRI）显示弥散加权成像（DWI）上有多个高信号梗死样病变。尽管6周后他的症状有所改善，但其中一些病变的高信号仍然存在。在首次发作18周后，患者出现发作性头晕和短暂失用事件。脑部MRI显示DWI上有额外高信号病变，即使7周后仍持续存在。最终，患者在首次发作39周后出现马尾综合征。脑部MRI显示，除了右侧额叶DWI上持续21周以上的高信号病变外，还出现了新的病变。根据实验室检查结果以及骨髓和随机皮肤活检的病理评估，该患者被诊断为血管内淋巴瘤（IVL）。脑部MRI的DWI上持续的高信号病变可能先于IVL的临床加重。
