PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA PRESENTING\ AS PARKINSONISM WITH ATYPICAL MRI FINDINGS AND ELEVATED 14-3-3 PROTEIN
Journal Title: International Journal Of Advances In Surgery - Year 2019, Vol 3, Issue 1
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare neoplasm with a incidence of 2-3% of all central nervous system malignancy. The diagnosis can be challenging especially with atypical presentations. Movement disorders can be one of the rare presentation of PCNSL. Here we present an unusual case of gradually progressing Parkinsonism with elevation of CSF 14-3-3 protein and atypical imaging findings found to have PCNL Case report:- A 76 year old Caucasian female referred to our center for an evaluation of the speech and intermittent speech difficulty. Initial work up revealed a contrast enhancing lesion in the bilateral putamen and head of caudate without any mass effect. Her symptoms were rapidly progressed and presented again within 6 months duration with mild dysarthria, bradykinesia, mild rigidity and reduced left arm swinging. This features were consistent with Parkinsonism. The repeat imaging showed progression of hyper intensities in the bilateral putamen. The other possibilities such as heavy metal poisoning, toxic, metabolic, inflammatory causes has been ruled out. Patient underwent stereotypic biopsy of the right caudate nucleus which reveled PCNSL. Patient underwent chemotherapy and currently in remission. Conclusion:- Diagnosis of movement disorders still remains clinical and rapid progression of symptoms, atypical presentation warrant further imaging and work up.
Authors and Affiliations
Elanagan Nagarajan, Sushma Y Reddy, Joel I Shenker, Pradeep C Bollu
Keywords
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