Yaura Kazuma, Watanabe Genya, Nakamura Takaaki, Tsukita Kenichi, Suzuki Hiroyoshi, Suzuki Yasushi
Department of Neurology, National Hospital Organization, Sendai Medical Center.
Department of Pathology, National Hospital Organization, Sendai Medical Center.
Rinsho Shinkeigaku. 2020 Mar 31;60(3):206-212. doi: 10.5692/clinicalneurol.cn-001373. Epub 2020 Feb 26.
Central nervous system intravascular lymphoma sometimes includes multiple lesions mimicking cerebral infarction. Herein, we report our experience with a case of intravascular large B-cell lymphoma (IVLBCL) with multiple hemorrhages. A 53-year-old woman was admitted to our hospital with clonic convulsions of the left upper limb. Brain MRI revealed a large number of high-intensity areas on FLAIR and low-intensity areas on susceptibility-weighted imaging (SWI). Chest CT showed bilateral multiple high-density lesions in the lungs. Biopsy of pulmonary lesions revealed no abnormal cells. Levetiracetam was administered to prevent the seizures that were assumed to occur due to the cerebral cortex lesions; however, convulsive seizure recurred with a depressed level of consciousness. On a repeat brain MRI examination, severe, multiple new lesions were shown to have developed bilaterally in the cerebral cortex and white matter, exhibiting spotty low intensities on SWI. Biopsy of a new cerebral lesion was carried out and the lesion was pathologically diagnosed as IVLBCL with hemorrhages. IVLBCL should be noted as one of the differential diagnoses not only in case with multiple infarct lesions, but also in case with multiple hemorrhages.
中枢神经系统血管内淋巴瘤有时包括多个类似脑梗死的病变。在此，我们报告一例伴有多处出血的血管内大B细胞淋巴瘤（IVLBCL）的诊疗经验。一名53岁女性因左上肢阵挛性抽搐入院。脑部MRI显示在液体衰减反转恢复序列（FLAIR）上有大量高信号区，在磁敏感加权成像（SWI）上有低信号区。胸部CT显示肺部双侧有多个高密度病变。肺部病变活检未发现异常细胞。给予左乙拉西坦预防因大脑皮质病变可能发生的癫痫发作；然而，抽搐性癫痫复发且意识水平下降。在重复脑部MRI检查时，显示双侧大脑皮质和白质出现严重的多个新病变，在SWI上表现为散在低信号。对新出现的脑部病变进行活检，病理诊断为伴有出血的IVLBCL。IVLBCL不仅应作为有多个梗死性病变病例的鉴别诊断之一，也应作为有多处出血病例的鉴别诊断之一。
