ATYPICAL PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA OR CRYPTOGENIC LEUKOENCEPHALOPATHY. CASE REPORT
Abstract:
We present a 67-year-old male patient with gait difficulties, disinhibited behaviour and
bipyramidal syndrome with left hemiataxia. In 2012, cerebral metastases were suspected and whole
brain radiation therapy was made with favourable evolution. No primary tumour or
paraneoplastic/autoimmune encephalitis pathology could be demonstrated in spite of extensive tests
(Magnetic Resonance Imaging - MRI studies, whole body Positron emission tomography/Computed
tomography - PET/CT, serum and cerebrospinal fluid (CSF) biochemical and immunological tests
including brain biopsy) during 3 years’ time. In 2015, the patient status aggravated, presenting severe
tetraparesis, left medullary syndrome and persistent altered consciousness. The patient received
methotrexate (MTX) therapy but the outcome was unfavourable 3 months later. Conclusions: The cause
of the Leukoencephalopathy remained uncertain although many tests were done. An atypical primary
central nervous system lymphoma (PCNSL) or an autoimmune encephalitis could be taken into account.
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