Intravascular lymphoma (IVL) is a rare, fatal disease, often presenting with neurological deficits. Here we describe 2 patients initially diagnosed with recurrent atherosclerotic cerebral infarction followed by accurate diagnosis of IVL by positron emission tomography with 18fluorodeoxyglucose (FDG-PET).
Case 1 is a 65-year-old man with dysarthria and mild right hemiparesis. Two days later, he was diagnosed with left cerebral infarction and severe stenosis of intracranial left internal carotid artery on magnetic resonance imaging. His clinical course and radiological findings are summarized in Figure 1. While N-isopropyl-p-[123I]iodoamphetamine single-photon emission computed tomography (IMP-SPECT) studies revealed increased IMP uptake in the left frontal lobe, oxygen 15 gas PET did not reveal any abnormalities. We could not find any appropriate reasons for this discrepancy. Almost 100 days after onset, FDG-PET revealed high FDG uptake in the left frontal lobe. Brain biopsy was performed and revealed large B-cell IVL. The patient received whole-brain irradiation and steroid treatment, which transiently improved his symptoms, but he died 7 months after onset.
Yamada S, Nishii R, Oka S, Higashi T, Yagi M, Satow T, Suzuki T, Saiki M. FDG-PET a Pivotal Imaging Modality for Diagnosis of Stroke-Onset Intravascular Lymphoma. Arch Neurol. 2010;67(3):366-367. doi:10.1001/archneurol.2010.6