Abstract Details

Title Intravascular Lymphoma Presenting with Spinal Cord Infarct and Recurrent Ischemic Strokes

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-022

Objective

Background

INTRODUCTION: Intravascular lymphoma (IVL) is a rare subtype of large cell lymphoma characterized by proliferation of lymphoma cells within the lumen of small blood vessels. It follows an aggressive course with rapidly progressive neurologic involvement and potentially fatal outcome. It is often difficult to diagnose pre-mortem due to the absence of obvious tumor or detectable malignant cells in the peripheral blood smear.

Design/Methods CASE PRESENTATION: A 62-year-old man presented with acute bilateral lower extremity weakness and bowel incontinence in the absence of back pain or trauma. His initial exam was normal. Whole spine MRI was unremarkable. The leg weakness subsequently worsened. MRI brain showed several infarctions within the pons, cortex, and subcortical white matter. He was started on anticoagulation for suspected underlying cardioembolic mechanism. Rapidly progressive clinical deterioration followed with altered consciousness, aphasia, and visual impairment. Repeat MRI brain showed new scattered multifocal infarctions supra- and infratentorially. Upon transfer to our facility for higher level of care, MRI thoracic spine revealed spinal cord infarction at T6-T7. CTA head and neck, advanced cardiac imaging, paraneoplastic panel, CSF analysis, hypercoagulable work-up, and conventional cerebral angiography were unremarkable, except for an elevated beta-2 microglobulin and gammopathy. Bone marrow biopsy was unremarkable. Based on progressive clinical deterioration and imaging findings, IVL was suspected, and was ultimately confirmed by brain biopsy. Histological sections showed medium and small sized vessels with intraluminal large, atypical CD20-positive B-lymphocytes with high nuclear to cytoplasmic ratio and large nuclei with vesicular chromatin. Ultimately, the patient was felt to have a "double expressor" (myc and bcl2) non-germinal center IVL.

Results NA

Conclusions DISCUSSION: IVL is a rare cause of acute spinal cord infarction and should be considered in the differential diagnosis of patients with acute myelopathy and recurrent ischemic strokes. Early diagnosis and treatment could potentially alter the course of the disease.

Authors/Disclosures
Stephanie Lyden, MD PRESENTER	Dr. Lyden has nothing to disclose.
Rima Dafer, MD (Rush University Medical Center)	Dr. Dafer has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly. Dr. Dafer has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Eli Lilly. Dr. Dafer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Anderson, Rasor, and partners.

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