Pearls from 1/18/2022 LEADS

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." 


  1. 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.
  2. 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.
  3. 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. 
  4. 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. 

Watch the recorded session

Duke Medicine Learning, Education, and Discussion Series (LEADS) takes place each Tuesday at 12 p.m. Learn more and see schedule of upcoming sessions.