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Washington University Experience | NEOPLASMS (HEMATOLYMPHOID) | Lymphoma, primary | 27A0 Case 27 History
Case 27 History ---- This woman of unrecorded age had carried a diagnosis of multiple sclerosis for two years since. Initially she presented with poor hand coordination and stiffness and drawing up of the right hand and fingers and later of the arm. She also developed a right leg weakness at that time and later acute expressive aphasia both of which were attributed to MS. Her condition gradually deteriorated until mid-1980 when she developed urinary incontinence, requiring a chronic indwelling Foley. She had been in a nursing home for several months prior to admission at BJC. Her overall course would have a primary progressive MS deterioration. The admitting impression at BJC was progressive neurologic disease involving multiple areas of the nervous system including the cerebellum, the cortical spinal tracts, basal ganglia, and sparing the optic nerves. Differential diagnostic possibilities included multiple sclerosis, vasculitis, a system degeneration, Wilson's disease, multifocal leukoencephalopathy, and, possibly, multiple emboli. The CT scan overall was felt to be compatible with a diagnosis of MS. Lumbar puncture revealed a glucose of 73, a protein of 72 and 13 white blood cells. Oligoclonal bands were positive by agarose gel electrophoresis but negative by isoelectric focusing. The CSF/IGG ratios were normal. Feeding gastrostomy was placed. The possibility of arteriography and brain biopsy were brought up to the patient's family but they refused. Sedimentation rate, ANA, and all other laboratory tests were within normal limits. The patient was discharged with an unknown diagnosis on Prednisone and Lioresal. She was transferred to a nursing home and her subsequent course is unclear. However, several weeks prior to her expiration she developed fevers felt to be secondary to upper respiratory infection. She died of presumed sepsis. ---- At autopsy the brain showed a mild degree of leptomeningeal cloudiness over the cerebral hemispheres bilaterally and evidence of bilateral cerebral edema. The general autopsy revealed no evidence of systemic neoplasm confirming this as a primary lymphoma of the central nervous system.
