Imamura Daichi, Fujiwara Satoru, Amagase Hiroki, Kawamoto Michi
Department of Neurology, Kobe City Medical Center General Hospital, Kobe, JPN.
Department of Hematology, Kobe City Medical Center General Hospital, Kobe, JPN.
Cureus. 2024 Jun 28;16(6):e63417. doi: 10.7759/cureus.63417. eCollection 2024 Jun.
The diagnosis of intravascular large B-cell lymphoma (IVLBCL) is often challenging owing to its nonspecific clinical manifestations and imaging findings. Herein, we present a rare case of IVLBCL in which seizure was the initial symptom, and unilateral hemispheric hyperperfusion on arterial spin labeling (ASL) was the only abnormal finding observed on brain magnetic resonance imaging (MRI). A 68-year-old male with a history of hypertension and type 2 diabetes was transferred to the emergency room owing to the sudden onset of altered consciousness and abnormal behavior. Upon arrival, the patient was disoriented and confused, and cerebrospinal fluid analysis revealed pleocytosis and elevated protein level. Even after the administration of acyclovir and antiepileptic drugs, his consciousness remained impaired, with repeated transient right hemiparesis indicating a focal seizure. The initial and follow-up MRI scans showed no obvious abnormalities in diffusion-weighted imaging (DWI), T2-weighted imaging, or susceptibility-weighted imaging (SWI); however, ASL revealed markedly increased blood flow to the left hemisphere. Subsequently, the rapid elevation of serum lactate dehydrogenase (LDH) and soluble interleukin-2 receptor (sIL-2R) levels after admission led to the diagnosis of IVLBCL by random skin biopsy and bone marrow examination. Despite the initiation of chemotherapy, the patient developed tumor lysis syndrome and succumbed to multiple organ failure. This case underscores the importance of considering IVLBCL in adult patients with refractory seizures and highlights the potential utility of ASL on MRI for early diagnosis.
血管内大B细胞淋巴瘤（IVLBCL）的诊断往往具有挑战性，因为其临床表现和影像学表现缺乏特异性。在此，我们报告一例罕见的IVLBCL病例，该病例以癫痫发作作为首发症状，而动脉自旋标记（ASL）显示单侧半球血流灌注增加是脑部磁共振成像（MRI）上观察到的唯一异常表现。一名68岁男性，有高血压和2型糖尿病病史，因意识改变和行为异常突然发作被转诊至急诊室。入院时，患者定向力障碍且意识模糊，脑脊液分析显示细胞数增多和蛋白水平升高。即使给予阿昔洛韦和抗癫痫药物治疗后，其意识仍未恢复，反复出现短暂性右侧偏瘫提示局灶性癫痫发作。初次及后续MRI扫描在弥散加权成像（DWI）、T2加权成像或磁敏感加权成像（SWI）上均未显示明显异常；然而，ASL显示左侧半球血流明显增加。随后，入院后血清乳酸脱氢酶（LDH）和可溶性白细胞介素-2受体（sIL-2R）水平迅速升高，通过随机皮肤活检和骨髓检查确诊为IVLBCL。尽管开始了化疗，但患者仍发生肿瘤溶解综合征，并死于多器官功能衰竭。该病例强调了在成年难治性癫痫患者中考虑IVLBCL的重要性，并突出了MRI上ASL在早期诊断中的潜在应用价值。
