E-Pearl of the Week: Intravascular B-cell Lymphoma

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April 15, 2013

Intravascular B-cell lymphoma is a rare but aggressive form of B-cell lymphoma that may be neurologically devastating. In this condition, there is luminal invasion of small and medium-sized blood vessels by lymphoma cells that may present as widespread and nonspecific neurologic symptoms and impairments. Intravascular lymphoma is often confused with CNS vasculitis because imaging may often demonstrate hyperintense DWI changes in a multi-vascular distribution, which is concerning for ischemia. [1] Diagnosis can be made by biopsy.  Although prognosis is poor, a prompt diagnosis and initiation of therapy may slow disease progression.  Rituximab-based chemotherapy regimens have recently been shown to double the progression-free survival period. [2]


  1. Baehring JM, Henchcliffe C, Ledezma CJ, Fulbright R, Hochberg FH.  Intravascular lymphoma: magnetic resonance imaging correlates of disease dynamics with the central nervous system.  J Neurol Neurosurg Psychiatry 2005; 76: 540-544.
  2. Raza M, Qayyum S, Raza S, Goorha S.  Intravascular B-Cell Lymphoma: An Elusive Diagnosis.  Journal of Clinical Oncology 2012; 30: e144-145.

Submitted by James Addington, M.D. Resident Physician, University of Virginia.

Disclosure: Dr. Addington reports no disclosures.

For more clinical pearls and other articles of interest to neurology trainees, visit the Neurology Residents & Fellows page. Listen to this week's Neurology Podcast.


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