A 29-year-old man presented with acute seizures and visual impairment. Brain magnetic
resonance imaging (MRI) showed multiple white matter T2-lesions with incomplete peripheral
enhancement ([Figures 1A to 1C]). Considering the hypothesis of acute disseminated encephalomyelitis, intravenous
methylprednisolone (IVMP) was administrated with full recovery. Two years later, he
presented right-sided weakness. MRI disclosed a new T2-lesion, and spectroscopy suggested
a tumefactive inflammatory pattern ([Figures 1D to 1H]). New extensive cerebrospinal fluid (CSF) and blood workup, including aquaporin-4-IgG,
was unremarkable. Partial improvement was observed following IVMP. Six months later,
after new weakness in the left arm along with a new periventricular lesion ([Figures 1I to 1L]), a brain biopsy was performed. Histopathological analysis revealed primary central
nervous system (CNS) lymphoma ([Figure 2])[1],[2],[3].
Figure 1 Magnetic resonance imaging exams. (A-C): first magnetic resonance imaging performed
on March 2016 indicated diffusion restriction on diffusion-weighted image (A), T2
hypersignal (B), and peripheral enhancement on post-contrast T1 sequences (C). D-H:
Neuroimaging performed on July 2018 showed a new lesion with peripheral restricted
diffusion on diffusion-weighted image (D), T2 hypersignal (E), thick annular enhancement
(F), spectroscopy revealed Cho peak increase (G) and minimal relative cerebral blood
volume map (rCBV) increase. (H). (I-L): Brain magnetic resonance imaging performed
on January 2019 disclosed a new right periventricular lesion with diffusion restriction
on diffusion-weighted image (I), mild T2 hyperintensity sequences (J), and homogeneous
contrast enhancement (L).
Figure 2 Histopathological examination showed atypical lymphoid cell proliferation.
