A 73-YEAR-OLD woman presented with progressive confusion over a 5-week period, after having become increasingly apathetic for the past several months and having lost 22.5 kg over the past 1 year.
On examination, the patient was normotensive and cachectic. Neurologically, there was psychomotor retardation with disorientation to place and time, complete visual loss except for a small preserved central focus, and denial for the degree of visual loss.
Cerebral T2 magnetic resonance images revealed large confluent areas of hyperintensity in the subcortical regions of the occipital and parietal lobes bilaterally, involving the U fibers but sparing the cortex (Figure 1A). Linear enhancement of the affected areas and the adjacent meninges was noted (Figure 1B).
Moussouttas M. Intravascular Lymphomatosis Presenting as Posterior Leukoencephalopathy. Arch Neurol. 2002;59(4):640. doi:10.1001/archneur.59.4.640