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• Vol.52 No.7
• CLINICA NEUROL, 52: 486−490, 2012
• Vol.52 No.7 contents

Case Report

Remission of lymphomatosis cerebri induced by corticosteroid and high-doses intravenous methotrexate

Mitsuru Watanabe, M.D.¹⁾, Hitoshi Satoi, M.D., Ph.D.¹⁾, Yuki Takahashi, M.D.²⁾, Namiko Nishida, M.D., Ph.D.²⁾, Hiroki Toda, M.D., Ph.D.²⁾ and Sadayuki Matsumoto, M.D., Ph.D.¹⁾

¹⁾Department of Neurology, Center of Neurology and Neurosurgery, Kitano Hospital, The Tazuke Kofukai Medical Research Institute
²⁾Department of Neurosurgery, Center of Neurology and Neurosurgery, Kitano Hospital, The Tazuke Kofukai Medical Research Institute

Lymphomatosis cerebri (LC) is a rare form of primary central nervous system lymphoma characterized by subacute progressive dementia and unsteady gait. MRI study of LC typically reveals diffuse leukoencephalopathy without contrast enhancement. The clinical presentation and MRI features of LC can resemble infectious, inflammatory, toxic or vascular leukoencephalopathy. Hence diagnosis of LC is easily mistaken for other, more common diseases. In this report, we present a case of a 55-year-old man presenting with subacute progressive dementia and ataxic gait. Brain MRI showed diffuse hyperintense lesions in the cerebral white matter of both hemispheres, left amygdala, brainstem and cerebellar peduncles on FLAIR image. No contrast-enhanced lesion was observed. Cerebrospinal fluid analysis showed elevated levels of soluble interleukin-2 receptor and β2-microglobulin. Based on MRI findings and ¹²³I-IMP SPECT, stereotactic biopsy targeting white matter of the left medial temporal lobe was performed (day 0). On the day after the brain biopsy, corticosteroid therapy was initiated and improved the patient's cognitive function and gait disturbance. Pathological diagnosis of large B-cell lymphoma was obtained on day 9. High-dose intravenous methotrexate chemotherapy was started on day 14 and led to complete remission by day 52. This case highlighted the importance of brain biopsy for diagnosis of LC. This report raises a possibility that timely and proper treatment leads to a favorable outcome of LC that has been regarded as an intractable disease with poor prognosis.
Full Text of this Article in Japanese PDF (690K)

(CLINICA NEUROL, 52: 486−490, 2012)
key words: lymphoma, lymphomatosis cerebri, magnetic resonance imaging, cognitive impairment, biopsy

(Received: 19-Sep-11)