A Rare Case of Primary Central Nervous System Lymphoma in an Adolescent Female Treated with High-Dose Methotrexate and Rituximab-Based Chemoimmunotherapy and Consolidation Whole Brain Radiotherapy

Diffuse Large B-Cell Lymphoma in Bilateral Basal Ganglia: A Rare Case Report

Primary central nervous system lymphoma (PCNSL) may affect the basal nuclei of the brain. The most common type is diffuse large B-cell lymphoma. This is a case report of an adolescent with rare bilateral lymphoma in the basal ganglia. A male patient aged 16 years had a clinical picture of rapid progression to motor aphasia, dysphagia, and right hemiplegia. Magnetic resonance imaging (MRI) of the skull, along with spectroscopy, indicated lymphoproliferative or neoplastic disease. A biopsy confirmed diffuse large B-cell lymphoma. However, the patient died before starting the definitive treatment. PCNSL is infrequent in the pediatric population, but it has a better prognosis in this age group, especially when diagnosed early. It affects immunodeficient patients more often. In addition to MRI, spectroscopy and positron-emission tomography help clarify the diagnosis. Biopsy is a gold standard for diagnosis, leading to the appropriate initiation of chemotherapy and radiotherapy treatment. PCNSL is rare in young patients. With an early diagnosis, better therapeutic planning is possible. Unfortunately, in the present case, the diagnosis was late, and the patient had an unfavorable outcome.

Seizures in steroid-responsive encephalopathy

Steroid-responsive encephalopathy is a general term for diseases that are characterized by diffuse brain injury and respond well to corticosteroids or immunosuppressive agents, including Hashimoto's encephalopathy (HE), limbic encephalitis (LE), systemic lupus erythematosus encephalopathy (SLEE), antineutrophil cytoplasmic antibodies (ANCA)-associated systemic vasculitis encephalopathy (AASV), viral encephalitis (VE), and primary central nervous system lymphoma (PCNSL). Epilepsy and status epilepticus are the main manifestations of steroid-responsive encephalopathy. The spectrum of "autoimmune epilepsy" diseases, which has been approved by the epilepsy diagnostic recommendations of the International Antiepileptic League, is characterized by a high prevalence of epilepsy in central nervous system (CNS) autoimmune diseases and a variety of neuron-specific autoantibodies. Steroid-responsive encephalopathy with different causes may have different pathogeneses and has been suggested to be associated with some internal commonality producing seizure as the main symptom. Determining the regularity of seizures caused by steroid-responsive encephalopathy and implementing appropriate measures will help us improve the prognosis of patients. This paper summarizes the epidemiology, seizure onset, seizure type, and other characteristics of seizures in steroid-responsive encephalopathy (including HE, LE, SLEE, ANCA-associated systemic vasculitis encephalopathy, VE, and PCNSL) and then discusses the use of antiepileptic drugs to treat steroid-responsive encephalopathy.