title: [MR spectroscopy findings of a case of intravascular malignant lymphoma: usefulness for differential diagnosis].
abstract: We report a 49-year-old previously healthy woman with acute onset of decrease in attention, dysarthria and ataxia, accompanied by drowsiness. On admission, there were cloudness of consciousness, hallucination and left hemiparesis. Cerebrospinal fluid study revealed a cell count of 1/mm3, and the cytology was class I with a slight increase in protein. MRI of the brain performed on admission showed multiple gadolinium-enhanced lesions with a T2 weighted high intensity area in the cerebral white matter. At first the patient was diagnosed as acute disseminated encephalomyelitis (ADEM), and treated with methylprednisolon pulse therapy. Soon after, she showed transient clinical improvement, but her condition soon worsened. MR spectroscopy revealed elevated choline peak, decreased NAA peak and lactate peak, which indicated a neoplastic lesion. The brain biopsy disclosed diffuse intravascular lymphoma (IVL). MRS was useful in the differential diagnosis of IVL from ADEM.
authors.affiliation: Department of Neurology, Tohoku University School of Medicine.
authors.forename: Naoki
authors.initials: N
authors.lastname: Suzuki
authors.forename: Makiko
authors.initials: M
authors.lastname: Nagai
authors.forename: Aya
authors.initials: A
authors.lastname: Ishigaki
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Onodera
authors.forename: Eiji
authors.initials: E
authors.lastname: Jokura
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Kumabe
authors.forename: Yusei
authors.initials: Y
authors.lastname: Shiga
authors.forename: Yasuto
authors.initials: Y
authors.lastname: Itoyama
mesh_terms: D001921:Brain / Q000098:blood supply / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008223:Lymphoma / Q000175:diagnosis* / Q000473:pathology; D009682:Magnetic Resonance Spectroscopy; D019043:Vascular Neoplasms / Q000175:diagnosis* / Q000473:pathology