title: Bilateral basal ganglia lesions as initial manifestation of CNS invasion in adult T-cell leukemia.
abstract: We describe the case of a 67-year-old man who exhibited unsteadiness in walking, topographical disorientation, and urinary incontinence. Neurological examination revealed somnolence and mild weakness in the lower limbs with slight rigidity in the upper limbs. Cerebrospinal fluid examination showed pleocytosis with "flower cells" and an extremely high level of soluble interleukin-2 receptor. T2-weighted brain imaging revealed symmetrical high-intensity lesions in the bilateral caudate putamen. Positron emission tomography demonstrated intense uptake of 2-[fluorine-18]-fluoro-2-deoxy-d-glucose in the same region. He was diagnosed with central nervous system invasion by adult T-cell leukemia (ATL) and received chemotherapy. Interestingly, chemotherapy ameliorated the lesions and terminally caused the gray matter itself to atrophy in the bilateral caudate nuclei, which may be evidence for the direct infiltration of ATL tumors.
authors: Department of Neurology, Graduate School of Medical Sciences, Kumamoto University 1-1-1 Honjo, Kumamoto 860-8556, Japan.
authors: Yoshimasa
authors: Y
authors: Matsuo
authors: Satoshi
authors: S
authors: Yamashita
authors: Shoji
authors: S
authors: Honda
authors: Makoto
authors: M
authors: Nakajima
authors: Akihiko
authors: A
authors: Ueda
authors: Tomoo
authors: T
authors: Hirahara
authors: Taro
authors: T
authors: Yamashita
authors: Yasushi
authors: Y
authors: Maeda
authors: Teruyuki
authors: T
authors: Hirano
authors: Yukio
authors: Y
authors: Ando
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001479:Basal Ganglia / Q000473:pathology*; D016543:Central Nervous System Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000556:secondary; D006801:Humans; D015458:Leukemia, T-Cell / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male
chemical_list: D000970:Antineoplastic Agents