title: Inflammatory demyelinating brain lesions heralding primary CNS lymphoma.
abstract: Brain biopsy plays a crucial role in the exploration of suspect white matter lesions in the differential diagnosis of primary central nervous system lymphoma (PCNSL) and inflammatory demyelination. We present the case of a previously healthy, immunocompetent woman, aged fifty-nine, who developed a histologically confirmed demyelinating white matter lesion months prior to the manifestation of a PCNSL. Similar cases of "sentinel lesions" preceding a PCNSL have been reported. In a literature review, we compared the diagnostic features that may be useful to differentiate a PCNSL from inflammatory demyelinating disease in older age. We conclude that the occurrence of large, contrast-enhancing cerebral lesions in older patients with a relapsing-remitting disease course and steroid-resistant vision disorders should lead to the consideration of a PCNSL.
authors.affiliation: Department of Neurology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Leila
authors.initials: L
authors.lastname: Husseini
authors.forename: Andreas
authors.initials: A
authors.lastname: Saleh
authors.forename: Guido
authors.initials: G
authors.lastname: Reifenberger
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Hartung
authors.forename: Bernd C
authors.initials: BC
authors.lastname: Kieseier
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D016543:Central Nervous System Neoplasms / Q000150:complications* / Q000473:pathology; D003711:Demyelinating Diseases / Q000175:diagnosis / Q000209:etiology; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000379:methods; D006801:Humans; D007249:Inflammation / Q000175:diagnosis* / Q000209:etiology*; D008223:Lymphoma / Q000150:complications* / Q000473:pathology; D011859:Radiography; D011877:Radionuclide Imaging