The January 18, 2022, session of Duke Medicine LEADS featured Amanda Broderick, MD, David Leverenz, MD, Alexandra Stefanovic, MD presenting "'Untangling the Mystery of Multifocal CNS Lesions."
Pearls
- A presentation of primary neurologic symptoms with multifocal central nervous system lesions can lead to a broad differential including autoimmune, infectious and neoplastic entities that may require thoughtful testing, imaging and expert consultants.
- Intravascular lymphoma is a rare, likely underdiagnosed, condition with variable symptoms, imaging findings and laboratory abnormalities that should be considered in patients with rapidly progressive neurologic and systemic symptoms.
- The most common laboratory findings include cytopenias, elevated lactate dehydrogenase and Beta2 microglobulin. Cerebrospinal fluid can sometimes have elevated protein, but presence of neoplastic cells is rare.
- Unlike over solid tumor malignancies and classic lymphomas, PET CT often does not detect intravascular lymphoma. Tissue biopsy of an involved organ is required for a diagnosis and many cases unfortunately end up only being diagnosed post-mortem.
Duke Medicine Learning, Education, and Discussion Series (LEADS) takes place each Tuesday at 12 p.m. Learn more and see schedule of upcoming sessions.