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Inflammatory Demyelinating Brain Lesions Heralding Primary CNS Lymphoma

Published online by Cambridge University Press:  02 December 2014

Leila Husseini ,
Andreas Saleh ,
Guido Reifenberger ,
Hans-Peter Hartung  and
Bernd C. Kieseier
Leila Husseini
Affiliation:
Department of Neurology, Heinrich-Heine University, Düsseldorf, Germany
Andreas Saleh
Affiliation:
Department of Radiology, Heinrich-Heine University, Düsseldorf, Germany
Guido Reifenberger
Affiliation:
Department of Neuropathology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
Hans-Peter Hartung
Affiliation:
Department of Neurology, Heinrich-Heine University, Düsseldorf, Germany
Bernd C. Kieseier*
Affiliation:
Department of Neurology, Heinrich-Heine University, Düsseldorf, Germany
*
Department of Neurology, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225 Düsseldorf, Germany.
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Abstract

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Brain biopsy plays a crucial role in the exploration of suspect white matter lesions in the differential diagnosis of primary central nervous system lymphoma (PCNSL) and inflammatory demyelination. We present the case of a previously healthy, immunocompetent woman, aged fifty-nine, who developed a histologically confirmed demyelinating white matter lesion months prior to the manifestation of a PCNSL. Similar cases of “sentinel lesions” preceding a PCNSL have been reported. In a literature review, we compared the diagnostic features that may be useful to differentiate a PCNSL from inflammatory demyelinating disease in older age. We conclude that the occurrence of large, contrast-enhancing cerebral lesions in older patients with a relapsing-remitting disease course and steroid-resistant vision disorders should lead to the consideration of a PCNSL.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 39 , Issue 1 , January 2012 , pp. 6 - 10
Copyright
Copyright © The Canadian Journal of Neurological 2012

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