J Clin Neurol.  2009 Jun;5(2):97-100. 10.3988/jcn.2009.5.2.97.

Stroke Mimicking Encephalopathy as an Initial Manifestation of Diffuse Large B-Cell Lymphoma

• Kim JM
• Jung KH
• Lee ST
• Park HK
• Chu K
• Roh JK

• KMID: 2287662
• DOI: http://doi.org/10.3988/jcn.2009.5.2.97

Abstract

BACKGROUND: Systemic lymphoma can be difficult to recognize due to its diverse manifestations. Paraneoplastic leukoencephalopathy has rarely been reported in the context of lymphoma.
CASE REPORT
We report a 45-year-old man with systemic lymphoma whose initial manifestation was sudden-onset leukoencephalopathy, mimicking stroke. This patient, who was eventually diagnosed with diffuse large B-cell lymphoma, initially presented with sudden cognitive impairment and gait disturbance. Radiological studies suggested a paraneoplastic leukoencephalopathy. Chemotherapy for lymphoma resulted in clinical and radiological improvement.
CONCLUSIONS
The presented case indicates that diffuse large B-cell lymphoma may initially appear as a treatable leukoencephalopathy.

Keyword

lymphoma; cerebral infarction; paraneoplastic; leukoencephalopathy

MeSH Terms

B-Lymphocytes
Cerebral Infarction
Gait
Humans
Leukoencephalopathies
Lymphoma
Lymphoma, B-Cell
Middle Aged
Stroke

Figure

• 

  Fig. 1 Brain MRI data. Brain MRI showing multifocal white-matter lesions with high signal intensity on fluid-attenuated inversion recovery (FLAIR), MRI, and DWI, with an increased apparent diffusion coefficient value. Compared to the initial image (A), the lesions were markedly increased after 4 weeks (B), and then decreased following systemic chemotherapy (C). DWI: diffusion weighted image, ADC: apparent diffusion coefficient.

• 

  Fig. 2 Whole-body FDG PET. Fusion PET with abdominal computed tomography (CT) revealed multiple hypermetabolic lesions involving the liver, lymph nodes, and both adrenal glands (A, B: white arrows). Brain PET did not show any significant alteration of metabolism (C: coronal image, D: axial image).

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