Intravascular Lymphoma with Progressive CNS Hemorrhage and Multiple Dissections
Introduction. Intravascular lymphoma (IVL) is an uncommon and often fatal disease characterized by intraluminal proliferation of lymphomatous cells within blood vessels. Because of a heterogeneous clinical presentation and lack of sensitive diagnostic protocols, diagnosis of IVL is most often made a...
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doaj-125a121fe4944663b7ca5139896780a62020-11-25T00:11:19ZengHindawi LimitedCase Reports in Neurological Medicine2090-66682090-66762020-01-01202010.1155/2020/61348306134830Intravascular Lymphoma with Progressive CNS Hemorrhage and Multiple DissectionsRicky Chen0Gurjeet Singh1J. Scott McNally2Cheryl A. Palmer3Adam de Havenon4Providence Brain & Spine Institute, Providence St. Vincent Medical Center, 9135 SW Barnes Road, Suite 461, Portland, OR 97225, USALegacy Medical Group Neurology, Salmon Creek Medical Center, 2121 NE 139th St., Suite 205 Medical Office Building A, Vancouver, WA 98686, USADepartment of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E, Salt Lake City, UT 84132, USADepartment of Pathology, University of Utah, Huntsman Cancer Institute, 2000 Circle of Hope Dr., Salt Lake City, UT 84112, USADepartment of Neurology, University of Utah, 175 N Medical Dr., Salt Lake City, UT 84132, USAIntroduction. Intravascular lymphoma (IVL) is an uncommon and often fatal disease characterized by intraluminal proliferation of lymphomatous cells within blood vessels. Because of a heterogeneous clinical presentation and lack of sensitive diagnostic protocols, diagnosis of IVL is most often made at autopsy. However, with early diagnosis and appropriate chemotherapy, the prognosis is greatly improved and complete remission is possible. In order to broaden the possible presentations of IVL, we present a patient with an atypical manifestation of biopsy-proven intravascular large B-cell lymphoma who suffered dissections of both intracranial and extracranial arteries in addition to progressive intracranial hemorrhages. Case Report. A 47-year-old woman presented with unilateral paresthesias. She developed progressive multifocal infarcts and hemorrhage with dissections of both intracranial and extracranial arteries, resulting in coma. Brain biopsy revealed IVL. She received aggressive chemotherapy and remains in complete remission with good neurologic recovery. Conclusion. IVL is known to exert its pathology on small arteries and capillaries, but is not known to cause dissections of large vessels. The diagnosis should be considered in cases with unexplained arterial dissections and progressive strokes. Early diagnosis with appropriate laboratory screening and tissue confirmation by biopsy can lead to greatly improved outcomes.http://dx.doi.org/10.1155/2020/6134830 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ricky Chen Gurjeet Singh J. Scott McNally Cheryl A. Palmer Adam de Havenon |
spellingShingle |
Ricky Chen Gurjeet Singh J. Scott McNally Cheryl A. Palmer Adam de Havenon Intravascular Lymphoma with Progressive CNS Hemorrhage and Multiple Dissections Case Reports in Neurological Medicine |
author_facet |
Ricky Chen Gurjeet Singh J. Scott McNally Cheryl A. Palmer Adam de Havenon |
author_sort |
Ricky Chen |
title |
Intravascular Lymphoma with Progressive CNS Hemorrhage and Multiple Dissections |
title_short |
Intravascular Lymphoma with Progressive CNS Hemorrhage and Multiple Dissections |
title_full |
Intravascular Lymphoma with Progressive CNS Hemorrhage and Multiple Dissections |
title_fullStr |
Intravascular Lymphoma with Progressive CNS Hemorrhage and Multiple Dissections |
title_full_unstemmed |
Intravascular Lymphoma with Progressive CNS Hemorrhage and Multiple Dissections |
title_sort |
intravascular lymphoma with progressive cns hemorrhage and multiple dissections |
publisher |
Hindawi Limited |
series |
Case Reports in Neurological Medicine |
issn |
2090-6668 2090-6676 |
publishDate |
2020-01-01 |
description |
Introduction. Intravascular lymphoma (IVL) is an uncommon and often fatal disease characterized by intraluminal proliferation of lymphomatous cells within blood vessels. Because of a heterogeneous clinical presentation and lack of sensitive diagnostic protocols, diagnosis of IVL is most often made at autopsy. However, with early diagnosis and appropriate chemotherapy, the prognosis is greatly improved and complete remission is possible. In order to broaden the possible presentations of IVL, we present a patient with an atypical manifestation of biopsy-proven intravascular large B-cell lymphoma who suffered dissections of both intracranial and extracranial arteries in addition to progressive intracranial hemorrhages. Case Report. A 47-year-old woman presented with unilateral paresthesias. She developed progressive multifocal infarcts and hemorrhage with dissections of both intracranial and extracranial arteries, resulting in coma. Brain biopsy revealed IVL. She received aggressive chemotherapy and remains in complete remission with good neurologic recovery. Conclusion. IVL is known to exert its pathology on small arteries and capillaries, but is not known to cause dissections of large vessels. The diagnosis should be considered in cases with unexplained arterial dissections and progressive strokes. Early diagnosis with appropriate laboratory screening and tissue confirmation by biopsy can lead to greatly improved outcomes. |
url |
http://dx.doi.org/10.1155/2020/6134830 |
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