Abstract
A rare case of intravascular lymphomatosis is described. A 73-year-old man presented with dementia, memory disturbance, character change, right homonymous hemianopsia and cerebellar ataxia. FLAIR MRI scans demonstrated multiple hyper-intensity lesions localized at the right frontal lobe, the genu of the corpus callosum, the left occipital lobe and the cerebellum. A craniotomy for lesions of the left occipital lobe was performed and pathological examination revealed proliferation of large B-cells within small arteries using the immunohistochemical technique. Whole brain irradiation (2 Gy × 25 = 50 Gy) was performed immediately after the diagnosis, followed by combined chemotherapy (C-VEPA; Ara-C, vincristine, cyclophosphamide, prednisolone and Adryacin). Symptoms and radiological findings have been stable for 11 months since diagnosis. While prognosis depends on early diagnosis and treatment, the diagnosis of intravascular lymphomatosis is not easy. This disease should be considered when a patient presents with progressive changes of mental status and focal neurological deficits over a few weeks or months. FLAIR MRI scans may be especially useful for diagnosis.
