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Spinal cord involvement in primary CNS lymphoma.

Arunmozhimaran Elavarasi1, Deepa Dash1, Anand R Warrier1

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Primary CNS lymphoma can mimic longitudinally extensive transverse myelopathy (LETM), a common syndrome. Early diagnosis requires considering PCNSL and performing CSF analysis before steroid treatment to avoid masking symptoms.

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Area of Science:

  • Neurology
  • Oncology

Background:

  • Longitudinally extensive transverse myelopathy (LETM) is a common neurological syndrome.
  • Primary CNS lymphoma (PCNSL) is rarely considered in the differential diagnosis of LETM.

Observation:

  • PCNSL can manifest as LETM, often presenting without contrast enhancement on MRI.
  • Corticosteroid treatment for presumed transverse myelitis can transiently improve symptoms and obscure the diagnosis of PCNSL.

Findings:

  • Failure to include PCNSL in the differential diagnosis delays appropriate treatment.
  • Cerebrospinal fluid (CSF) analysis is crucial for diagnosis and should ideally precede corticosteroid administration.
  • Repeated CSF examinations may be necessary to confirm PCNSL.

Implications:

  • Increased awareness of PCNSL as a cause of LETM is essential for timely diagnosis.
  • Adherence to diagnostic protocols, including pre-treatment CSF analysis, can prevent diagnostic delays.
  • Early and accurate diagnosis of PCNSL enables prompt initiation of effective treatment strategies.