Intravascular lymphoma with conus medullaris syndrome followed by encephalopathy.
BACKGROUND
Intravascular large cell lymphoma (ILCL) is a diagnostic challenge, with neurological, cutaneous and constitutional symptoms. The natural history is usually an evolution to a comatose state. As invasive procedures are usually required for diagnosis, recognizing the typical clinical pattern is critical since an effective treatment is available.


METHODS
After an extensive literature review of the subject, we report a case of ILCL, analyzing clinical, laboratory, radiological and pathological data. We will also give a special attention to the clinical picture of a conus medullaris (CM) lesion with subsequent encephalopathy in the same patient,


RESULTS
We report here a 61-year-old woman with a paraplegia caused by a CM lesion, evolving about one year latter to encephalopathy and eventual coma, with the diagnosis of ILCL confirmed by autopsy. The present case is similar to eight other cases in literature who had CM lesion associated with ILCL, knowing that 80-90% of these patients will eventually evolve to encephalopathy without treatment.


CONCLUSIONS
ILCL is a recognized but rare cause of coma. Diagnosing it is tremendously important since it is fatal if left untreated. We propose that this specific picture (conus medullaris lesion, eventually evolving to encephalopathy) is quite characteristic and will directly result in better outcome if recognized.
Savard
Martin
M
Hôpital de ll'Enfant-Jésus du CHA, Laval University, Quebec City, Quebec, Canada.
Verreault
Steve
S
Gould
Peter V
PV
Bernier
Vincent
V
Bouchard
Jean-Pierre
JP
D001927:Brain Diseases / Q000209:etiology / Q000473:pathology*; D001932:Brain Neoplasms / Q000150:complications / Q000473:pathology; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000473:pathology*; D008875:Middle Aged; D009187:Myelitis / Q000209:etiology / Q000473:pathology*; D013117:Spinal Cord Compression / Q000209:etiology* / Q000473:pathology; D013125:Spinal Neoplasms / Q000150:complications / Q000473:pathology*; D013904:Thoracic Vertebrae; D019043:Vascular Neoplasms / Q000150:complications / Q000473:pathology*