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Transient Global Amnesia as the First Clinical Symptom for Malignant B-Cell Lymphoma with Central Nervous System Involvement.

Zafar A, Khan GI, Abdin S, Khan MT - Case Rep Neurol Med (2015)

Bottom Line: We present the case of an elderly male who was diagnosed with transient global amnesia (TGA), only to be diagnosed with B-cell lymphoma with central nervous system involvement a few weeks later.This is the first ever case reported in literature with lymphoma presenting as TGA.Literature review and pertinent points regarding high-yield imaging protocol for presumed TGA patients are discussed.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.

ABSTRACT
We present the case of an elderly male who was diagnosed with transient global amnesia (TGA), only to be diagnosed with B-cell lymphoma with central nervous system involvement a few weeks later. This is the first ever case reported in literature with lymphoma presenting as TGA. Literature review and pertinent points regarding high-yield imaging protocol for presumed TGA patients are discussed.

No MeSH data available.


Related in: MedlinePlus

The first row shows brain MRI (from left to right, DWI, FLAIR, and T1+C) from first ER visit with presumed TGA: arrows show subtle signal changes that were too mild to be called. The middle row shows brain MRI (from left to right, DWI, FLAIR, and T1+C) six weeks from his first presentation: signal changes in DWI, FLAIR in hippocampus; moreover, there is enhancement in hippocampus and medial temporal lobe. The lowest row shows that brain MRI after treatment shows subtle improvement in hippocampus and temporal areas.
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Related In: Results  -  Collection


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fig1: The first row shows brain MRI (from left to right, DWI, FLAIR, and T1+C) from first ER visit with presumed TGA: arrows show subtle signal changes that were too mild to be called. The middle row shows brain MRI (from left to right, DWI, FLAIR, and T1+C) six weeks from his first presentation: signal changes in DWI, FLAIR in hippocampus; moreover, there is enhancement in hippocampus and medial temporal lobe. The lowest row shows that brain MRI after treatment shows subtle improvement in hippocampus and temporal areas.

Mentions: Two weeks after discharge, the patient's family reported that he has been sleeping half the day since he was discharged. Upon evaluation in the ER a few days later, there were no new findings on neurological exam. Six weeks after his first presentation, an urgent clinic appointment was set up with a brain MRI due to concerns of fatigue, progressive worsening of balance, cognition, and intermittent left sided weakness. Imaging showed nonnodular meningeal enhancement. Figure 1 shows Magnetic Resonance Imaging (MRI) done at first encounter, comparing it to the sequences at six weeks and post-treatment. The patient was worked up with multiple CSF analysis, flow cytometry, CT scan, and bone marrow biopsy, leading to an eventual diagnosis of malignant B-cell lymphoma with spread to the CNS (subtype could not be classified). The patient underwent chemotherapy but expired 11 months after the diagnosis, 13 months from his first presentation with what was believed to be TGA.


Transient Global Amnesia as the First Clinical Symptom for Malignant B-Cell Lymphoma with Central Nervous System Involvement.

Zafar A, Khan GI, Abdin S, Khan MT - Case Rep Neurol Med (2015)

The first row shows brain MRI (from left to right, DWI, FLAIR, and T1+C) from first ER visit with presumed TGA: arrows show subtle signal changes that were too mild to be called. The middle row shows brain MRI (from left to right, DWI, FLAIR, and T1+C) six weeks from his first presentation: signal changes in DWI, FLAIR in hippocampus; moreover, there is enhancement in hippocampus and medial temporal lobe. The lowest row shows that brain MRI after treatment shows subtle improvement in hippocampus and temporal areas.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4508470&req=5

fig1: The first row shows brain MRI (from left to right, DWI, FLAIR, and T1+C) from first ER visit with presumed TGA: arrows show subtle signal changes that were too mild to be called. The middle row shows brain MRI (from left to right, DWI, FLAIR, and T1+C) six weeks from his first presentation: signal changes in DWI, FLAIR in hippocampus; moreover, there is enhancement in hippocampus and medial temporal lobe. The lowest row shows that brain MRI after treatment shows subtle improvement in hippocampus and temporal areas.
Mentions: Two weeks after discharge, the patient's family reported that he has been sleeping half the day since he was discharged. Upon evaluation in the ER a few days later, there were no new findings on neurological exam. Six weeks after his first presentation, an urgent clinic appointment was set up with a brain MRI due to concerns of fatigue, progressive worsening of balance, cognition, and intermittent left sided weakness. Imaging showed nonnodular meningeal enhancement. Figure 1 shows Magnetic Resonance Imaging (MRI) done at first encounter, comparing it to the sequences at six weeks and post-treatment. The patient was worked up with multiple CSF analysis, flow cytometry, CT scan, and bone marrow biopsy, leading to an eventual diagnosis of malignant B-cell lymphoma with spread to the CNS (subtype could not be classified). The patient underwent chemotherapy but expired 11 months after the diagnosis, 13 months from his first presentation with what was believed to be TGA.

Bottom Line: We present the case of an elderly male who was diagnosed with transient global amnesia (TGA), only to be diagnosed with B-cell lymphoma with central nervous system involvement a few weeks later.This is the first ever case reported in literature with lymphoma presenting as TGA.Literature review and pertinent points regarding high-yield imaging protocol for presumed TGA patients are discussed.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.

ABSTRACT
We present the case of an elderly male who was diagnosed with transient global amnesia (TGA), only to be diagnosed with B-cell lymphoma with central nervous system involvement a few weeks later. This is the first ever case reported in literature with lymphoma presenting as TGA. Literature review and pertinent points regarding high-yield imaging protocol for presumed TGA patients are discussed.

No MeSH data available.


Related in: MedlinePlus