Short case...Subependymal primary CNS lymphoma

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Short case...Subependymal primary CNS lymphoma

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Short case...Subependymal primary CNS lymphoma

  1. 1. Short case publication... version 2.3 | Edited by professor Yasser Metwally | October 2008 Short case Edited by Professor Yasser Metwally Professor of neurology Ain Shams university school of medicine Cairo, Egypt Visit my web site at: http://yassermetwally.com A 30 years old male patient presented clinically with manifestations of increased intracranial pressure, bilateral papilledema, lower cranial nerve palsy, personality changes and hypothalamic manifestations DIAGNOSIS: PRIMARY SUBEPENDYMAL CNS LYMPHOMA
  2. 2. Figure 1. Postcontrast CT scan study showing a densely enhanced periventricular lesions. The lesions are seen completely surrounding the 4th, lateral and third ventricles with some perilesional edema lucencies. The lesions have a minimal mass effect and do not appear to be compressing the ventricular system or inducing obstructive hydrocephalus. The periventricular lesions are ensheathing the ventricular system and appear to radiate from it centrifugally outwards forming butterfly lesions around the 4th ventricle and the frontal horns of the lateral ventricles. Figure 2. Postcontrast CT scan study showing a densely enhanced periventricular lesions. The lesions are seen completely surrounding the lateral and the third ventricles with some perilesional edema lucencies. The lesions have a minimal mass effect and do not appear to be compressing the ventricular system or inducing obstructive hydrocephalus. The periventricular lesions are ensheathing the ventricular system and appear to radiate from it centrifugally outwards forming butterfly lesions the frontal horns of the lateral ventricles.
  3. 3. Figure 3. A, postcontrast CT scan study, B, and C are pre and postcontrast MRI T1 studies. Notice the densely enhanced butterfly lesions that completely encircled the 4th ventricle. Figure 4. Postcontrast MRI T1 images. Notice the periventricular lymphomatous sheath that completely encircled the ventricular system and appear to radiate from it centrifugally outwards forming butterfly lesions around the 4th ventricle. The periventricular lymphomatous sheath is densely enhanced and do not seem to encroach upon the ventricular system or induce significant compression on its borders. The ventricular system, however, are mildly dilated.
  4. 4. Figure 5. The periventricular disease completely disappeared after steroid therapy which is typical for Primary CNS lymphoma. Figure 6. The periventricular disease completely disappeared after steroid therapy which is typical for Primary CNS lymphoma.
  5. 5. The patient was subjected to stereotactic brain biopsy that revealed a primary CNS lymphoma. Staging did not reveal extraneural dissemination of the disease. The patient was referred to the oncology department for further management Addendum A new version of short case is uploaded in my web site every week (every Saturday and remains available till Friday.) To download the current version follow the link quot;http://pdf.yassermetwally.com/short.pdfquot;. You can download the long case version of this short case during the same week from: http://pdf.yassermetwally.com/case.pdf or visit web site: http://pdf.yassermetwally.com To download the software version of the publication (crow.exe) follow the link: http://neurology.yassermetwally.com/crow.zip At the end of each year, all the publications are compiled on a single CD-ROM, please contact the author to know more details. Screen resolution is better set at 1024*768 pixel screen area for optimum display For an archive of the previously reported cases go to www.yassermetwally.net, then under pages in the right panel, scroll down and click on the text entry quot;downloadable short cases in PDF formatquot; Also to view a list of the previously published case records follow the following link (http://wordpress.com/tag/case- record/) or click on it if it appears as a link in your PDF reader References 1. Metwally, MYM: Textbook of neurimaging, A CD-ROM publication, (Metwally, MYM editor) WEB-CD agency for electronic publishing, version 9.4a October 2008

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