Primary brain T-cell lymphoma of the lymphoblastic type presenting as altered mental status.
The authors present a case of a 56-year-old man with altered mental status. Magnetic resonance imaging (MRI) of the brain revealed non-enhancing abnormalities on T2 and FLAIR imaging in the brainstem, cerebellum, and cerebrum. Immunohistochemisty demonstrated precursor T-cell lymphoblastic lymphoma. After treatment with methotrexate, he improved clinically without focal sensorimotor deficits and with improving orientation. MRI showed almost complete resolution of brainstem and cerebral lesions. To the authors' knowledge, there are only five previous reports of primary central nervous system T-cell lymphoblastic lymphoma. Since treatable, it deserves consideration in patients with altered mental status and imaging abnormalities that include diffuse, non-enhancing changes with increased signal on T2-weighted images.
Clark
Aaron J
AJ
Deparment of Neurosurgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA. Aaron.Clark@ucsfmedctr.org
Lee
Kangmin
K
Broaddus
William C
WC
Martin
Mary Jo
MJ
Ghatak
Nitya R
NR
Grossman
Catherine E
CE
Baker
Sherman
S
Baykal
Ahmet
A
D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage; D001706:Biopsy; D001932:Brain Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D007150:Immunohistochemistry; D007275:Injections, Intravenous; D007278:Injections, Spinal; D008279:Magnetic Resonance Imaging; D008297:Male; D001523:Mental Disorders / Q000209:etiology*; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D054218:Precursor T-Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology*
D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate