Central nervous system Hodgkin's disease relapsing with eosinophilic pleocytosis

Hodgkin's disease affecting the central nervous system is infrequent. Multiple lumbar punctures are sometimes required for cytological diagnosis. In this case fluoroscopy-guided cisternal puncture and routine lumbar punctures were used to obtain cerebrospinal fluid (CSF) samples for cytological analysis. Reed-Sternberg cells were observed on the CSF sample obtained through the cisternal puncture while none were seen in the samples obtained with routine lumbar punctures. Without cytology, the diagnosis of meningeal carcinomatosis remains elusive. In conclusion, cisternal punctures should be entertained early in the evaluation for meningeal carcinomatosis, particularly if lumbar punctures have been unsuccessful.