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Neuropathology
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Case 2 -
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Primary CNS Diffuse Large B-cell Lymphoma
M. Bea Lopes, University of Virginia Health Science Center, Charlottesville, VA
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Clinical History
The patient is a 72-year-old gentleman with no previous history of neurologic disease who was referred to University of Virginia with history of subacute altered mental status and multiple brain lesions. The patient developed urinary incontinence three weeks prior presentation followed by episodes of confusion, ataxia, and slurred speech. CT and MRI of the brain at the outside hospital showed cerebral edema and about 7 enhancing lesions concerning from metastases versus infection. CT scans of the chest, abdomen, and pelvis were unremarkable. The patient was noted to have only an intention tremor at the outside hospital on neurological exam. The patient was placed on dexamethasone at the outside hospital and transferred to the University of Virginia. Of note, the patient had a PSA at an outside hospital about a year ago that was within normal limits, and also had a fecal occult blood was negative. The patient presented to University of Virginia with continued ataxia and confusion. He denied any fevers, chills, shortness of breath, neck pain, nausea, vomiting, or diarrhea. No weight loss. No night sweats. The patient complained of occasional paresthesias at his fingertips. On arrival, the patient's temperature was 36.2 degrees, blood pressure was 150/74, pulse was 62, respiratory rate 16, O2 saturation was 97% on room air. In general, the patient was in no apparent distress, alert and oriented to person and that he was in the hospital. However, he was not oriented to date or specific situation, also had occasional slurred speech. The patient's HEENT exam was unremarkable. Remaining physical exam was unremarkable. Neurologic exam showed the cranial nerves, II through XII are intact. Sensation was intact. He had 5/5 strength throughout. Cerebellar exam did show finger-to-nose dysmetria and slowing of alternating hand movements. He was unable to walk secondary to ataxia. He also had an intention tremor bilaterally. The patient underwent biopsy of one of the brain lesions on the same day as arrival.
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