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A spinal cord intravascular lymphomatosis with exceptionally good outcome

Intravascular lymphomatosis (IVL) is a rare form of high-grade malignant non-Hodgkin’s lymphoma, characterized by the proliferation of neoplastic lymphoid cells within the lumen of small-caliber blood vessels, producing localized vascular occlusion. CNS involvement is found in 75 to 85% of cases.1,2⇓ The clinical presentation is variable and can mimic other neurologic conditions.3 We report a patient with IVL presenting with an isolated, rapidly progressive spinal cord syndrome.

A 71-year-old retired woman was admitted because of rapidly progressive paraparesis, accompanied by dysuria and urinary incontinence. At admission, neurologic examination revealed paraparesis with a pyramidal syndrome, T12 hypoesthesia, and anal hypotonia. The rest of the examination was normal. Laboratory studies showed an elevated erythrocyte sedimentation rate and C-reactive protein. Spinal MRI revealed an increase in the size of the conus medullaris and a high signal in T2-weighted sequences. There was no gadolinium enhancement in T1-weighted sequences. Spinal ischemia was diagnosed. Cardiac and aortic ultrasonography were normal and a spinal arteriography …