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- Masaomi Yamamoto, Tomohisa Dembo, Keisuke Sawada, Baku Hashimoto, Satoru Ouji, and Kenichi Kaida.
- Department of Neurology, Saitama Medical Center, Saitama Medical University, Japan.
- Intern. Med. 2024 Nov 8.
AbstractA 75-year-old man presented with cognitive decline, headaches, and ataxic gait. Magnetic resonance imaging (MRI) revealed acute infarcts in multiple brain regions, and vessel wall MRI (VW-MRI) demonstrated concentric arterial wall thickening and enhancement in some intracranial arteries, initially suggesting primary central nervous system vasculitis (PCNSV). Despite immunosuppressive therapy, the patient developed further infarction. A skin biopsy revealed intravascular large B-cell lymphoma (IVLBCL), and autopsy revealed tumor cells in the arterial walls corresponding to the VW-MRI findings. This case highlights the risk of a misdiagnosis of PCNSV based solely on imaging findings and underscores the need for histological confirmation.
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