Skip to main content

Table 1 Clinical course timeline

From: Demyelination as a harbinger of lymphoma: a case report and review of primary central nervous system lymphoma preceded by multifocal sentinel demyelination

Date

Event

October 10–15, 2009

A 57 year-old woman with no significant past medical history presents with 6 weeks of fatigue, confusion and headache, with physical exam revealing right inferior homonymous quadrantanopsia, mild right hemiparesis and a wide-based gait admitted for evaluation of multiple brain lesions

 

Brain MRI revealed multiple enhancing lesions, including right frontal and left parieto-occipital mass lesions concerning for neoplasm

 

Patient was treated with pre-operative corticosteroids for 3 days

October 28

Biopsy of the left parieto-occipital lesion revealed mononuclear infiltrates with evidence of demyelination, but without evidence of malignancy

 

Patient was treated with a second round of intravenous corticosteroids for presumed acute disseminated encephalomyelitis or tumefactive multiple sclerosis

 

Patient was discharged home after showing rapid clinical improvement

November 23

Over the course of several weeks, the patient developed progressive dysarthria and right-sided weakness, prompting readmission to the hospital

 

A repeat brain MRI showed an increase in the size of the left-sided lesions, with vasogenic edema and subfalcine herniation

November 25

Patient refused a repeat brain biopsy

November 27

Patient was treated with a third round of intravenous corticosteroids and rituximab infusions, resulting in symptomatic improvement and discharge from the hospital

April 13, 2010

Over the following five months, after initial improvement, the patient again developed progressively worsening right hemiparesis and dysarthria, resulting in a second hospital readmission

 

MRI of the brain showed enlargement of the prior intracranial lesions with nodular enhancement suggestive of neoplasm

May 25

A second brain biopsy of the left parietal lesion was consistent with diffuse large B-cell lymphoma

 

Patient was treated with high dose methotrexate and leucovorin

June 7

In light of her continued clinical deterioration despite treatment, the patient was transferred to hospice care

 

Patient passed away in hospice care