Intravascular Lymphoma with Progressive CNS Hemorrhage and Multiple Dissections

Area of Science:

• Oncology
• Neurology
• Vascular Medicine

Background:

• Intravascular lymphoma (IVL) is a rare, often fatal hematologic malignancy.
• Typically, IVL affects small vessels, leading to diagnosis often at autopsy.
• Early detection and chemotherapy can lead to remission and improved prognosis.

Observation:

• A 47-year-old woman presented with paresthesias, progressing to multifocal infarcts and intracranial hemorrhages.
• The patient experienced dissections of both intracranial and extracranial arteries, leading to coma.
• Brain biopsy confirmed intravascular large B-cell lymphoma.

Findings:

• This case demonstrates IVL causing dissections in large intracranial and extracranial arteries, an atypical presentation.
• The patient's presentation included progressive strokes and hemorrhages.
• Despite the severe presentation, the patient achieved complete remission with chemotherapy.

Implications:

• IVL should be considered in patients with unexplained arterial dissections and progressive strokes.
• This case broadens the understanding of IVL's pathological manifestations.
• Timely diagnosis through biopsy and appropriate treatment are crucial for favorable outcomes in IVL.