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Kitahara S, Kanazawa M, Natsumeda M, Sato A, Ishikawa M, Hara K, Tabe H, Makino K, Okamoto K, Fujita N, Kakita A, Fuji Y, Onodera O. Progressive conus medullaris lesions are suggestive of intravascular large B-cell lymphoma. Eur J Neurol 2023; 30:3236-3243. [PMID: 37350144 DOI: 10.1111/ene.15941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND AND PURPOSE Spinal cord lesions are observed in 40% of all central nervous system lesions in intravascular large B-cell lymphoma (IVLBCL). However, because IVLBCL is a very rare disease, its clinical features are not well defined, which may delay appropriate diagnosis and treatment, whilst the acute to subacute course of brain lesions in patients with IVLBCL is well established. Therefore, this study aimed to clarify the clinical features of spinal cord lesions in patients with IVLBCL. METHODS The medical records of patients with IVLBCL admitted to our hospital between 2010 and 2020 were searched. The inclusion criteria were preceding neurological symptoms without non-neurological symptoms and pathologically confirmed IVLBCL in various organs. Clinical features of spinal cord involvement in patients with IVLBCL were assessed and distinguished from those of brain involvement. RESULTS Sixteen consecutive patients with IVLBCL were divided into two groups: six patients with spinal involvement (spinal cord type) and 10 patients with brain involvement (brain type). In the spinal cord type, four patients had chronic progression and two had subacute progression. Acute progression (0% vs. 80.0%) and sudden onset (0% vs. 50.0%) occurred significantly less frequently in the spinal cord than in the brain. All spinal cord lesions involved the conus medullaris. CONCLUSIONS Spinal cord involvement in IVLBCL has a predominantly chronic progressive course that is exclusive to brain involvement. Conus medullaris lesions are suggestive of IVLBCL and are useful for early and accurate diagnosis and treatment.
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Affiliation(s)
- Sho Kitahara
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Masato Kanazawa
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Manabu Natsumeda
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Aki Sato
- Department of Neurology, Niigata City General Hospital, Niigata, Japan
| | - Masanori Ishikawa
- Department of Neurology, Niigata Prefectural Central Hospital, Niigata, Japan
| | - Kenju Hara
- Department of Neurology, Akita Red Cross Hospital, Akita, Japan
| | - Hiroyuki Tabe
- Department of Neurology, Niigata Prefectural Central Hospital, Niigata, Japan
| | - Kunihiko Makino
- Department of Neurology, Niigata Prefectural Shibata Hospital, Niigata, Japan
| | - Kouichirou Okamoto
- Department of Translational Research, Brain Research Institute, Niigata University, Niigata, Japan
| | - Nobuya Fujita
- Department of Neurology, Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - Akiyoshi Kakita
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Yukihiko Fuji
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Osamu Onodera
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
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AlTahan HA, Amer RR, Madani AA, Bakhsh EA. An Unusual Cause of Cauda Equina Syndrome: Lumbar Epidural Venous Engorgement. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:694-698. [PMID: 29904039 PMCID: PMC6034556 DOI: 10.12659/ajcr.908793] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 02/28/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Epidural venous plexus (EVP) engorgement occurs due to many conditions, so it can be easily misdiagnosed. This becomes problematic when the diagnosis requires prompt treatment for a good outcome, especially when it results in cauda equina syndrome (CES). We report a case of extensive iliocaval thrombosis leading to epidural venous plexus and ascending lumbar vein engorgement as an outcome of deep venous thrombosis (DVT) due to probable adverse effects of oral combined contraceptive pills (OCCP). CASE REPORT A 42-year-old woman presented to a rural medical facility with bilateral lower-limb swelling and skin darkening for 2 days. She was transferred to a tertiary medical facility where her condition deteriorated to severe CES. A lower-limbs ultrasonography confirmed the presence of extensive DVT extending to the lower segment of the inferior vena cava. Spine magnetic resonance imaging showed abnormal enhancement of the conus medullaris with thick enhanced cauda equina nerve roots, consistent with a possible case of Guillain-Barré syndrome. However, there was engorgement of the EVP extending to the ascending lumbar, azygos, and hemiazygos veins, which was misdiagnosed. The patient was managed immediately with low-molecular-weight heparin and steroids. She died 4 weeks after admission due to hospital-acquired pneumonia and acute respiratory distress syndrome, probably due to the high dose of steroids. CONCLUSIONS Acute CES has a wide differential diagnosis. This report describes an unusual cause of CES and emphasizes the importance of early recognition to avoid misdiagnosis and management delay. Early identification of this clinical entity markedly decreases morbidity and mortality and thus improves the prognosis. Likewise, underlying causing factors such as venous congestion due to OCCP-related DVT should be considered in the diagnosis.
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Affiliation(s)
- Husam A. AlTahan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Roaa R. Amer
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Areej A. Madani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Eman A. Bakhsh
- Department of Neuroradiology, King Fahad Medical City, Riyadh, Saudi Arabia
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Hull JE, Jennings WC, Cooper RI, Waheed U, Schaefer ME, Narayan R. The Pivotal Multicenter Trial of Ultrasound-Guided Percutaneous Arteriovenous Fistula Creation for Hemodialysis Access. J Vasc Interv Radiol 2018; 29:149-158.e5. [DOI: 10.1016/j.jvir.2017.10.015] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 09/13/2017] [Accepted: 10/15/2017] [Indexed: 11/26/2022] Open
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Junpaparp P, Samiappan A, Buppajarntham S, Newman G. A Report of Congestive Myelopathy as a Result of Chronic Chylous Reflux Syndrome. J Clin Neurol 2014; 10:276-7. [PMID: 25045384 PMCID: PMC4101108 DOI: 10.3988/jcn.2014.10.3.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 01/10/2014] [Accepted: 01/10/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
- Parichart Junpaparp
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Ambiga Samiappan
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | | | - George Newman
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
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