39F | Progressive cognitive decline, headache, left homonymous hemianopsia, ataxia | Brain biopsy: intravascular large B cell lymphoma | Relapsing multifocal lesions involving cortex and subcortical white matter; enhancement with gadolinium; acute infarctions (DWI hyperintense) followed by laminar necrosis and tissue loss | Not done |
54F | Floaters both eyes, progressively diminished vision | Skin biopsy: intravascular large B cell lymphoma | T2 hyperintense lesion within left optic nerve; pontine and bilateral subcortical white matter lesions (FLAIR hyperintense), few of them with mild restriction of proton diffusion and contrast enhancement; resolution of DWI, contrast enhancement and partially of FLAIR abnormalities with chemotherapy | Not done |
60M | Lethargy | Gastrocnemius muscle biopsy: intravascular large B cell lymphoma | Initial scan negative; multiple, mostly cortical lesions (hyperintense on DWI), evolution over 12 days; no contrast enhancement | Not done |
72M | Progressive paraparesis over 2 weeks, Korsakoff-like psychosis | No biopsy done Cerebrospinal fluid cytopathology: increased number of lymphocytes, some atypical forms Flow cytometry: CD19+, CD20+, CD5+, CD10−, CD23− B cells with excess expression of κ light chain suggestive of B cell lymphoma Clonal IgH gene rearrangement in spinal fluid | Heterogeneously enhancing extra-axial frontal mass; punctate periventricular enhancement; resolution of contrast enhancement with therapy, haemorrhage into frontal extra-axial lesion | Diffuse cervicothoracic myelopathy (hyperintense on FLAIR), punctate parenchymal and leptomeningeal enhancement; resolution with chemotherapy |
79M | Progressive quadriparesis, lower extremity numbness over 1 month, neurogenic bladder dysfunction, encephalopathy, history of large B cell lymphoma | Clonal IgH gene rearrangement in spinal fluid | Multifocal subcortical small vessel infarcts (DWI hyperintense) | Hyperintense FLAIR signal and enhancement, most prominent in thoracic cord; enlargement, enhancement of lumbosacral nerve roots |