Key result
A 76-year-old female with rapidly progressing Parkinsonism was diagnosed with primary central nervous system lymphoma and achieved remission following treatment with high-dose methotrexate.
Why the study?
Primary central nervous system lymphoma is a rare neoplasm whose diagnosis can be challenging, especially when presenting with atypical features such as movement disorders.
Case Report (n=1)
Primary central nervous system lymphoma can rarely present as rapidly progressing Parkinsonism, highlighting the need for further imaging and workup in atypical presentations.
Rapidly progressive parkinsonism may indicate PCNSL; this case leaves open prevalence and optimal management in larger cohorts.
Primary central nervous system lymphoma (PCNSL) is a rare neoplasm with an incidence of 2 to 3% of all CNS malignancies. The diagnosis can be challenging, especially with atypical presentations. Movement disorders can be one of the rare presentations of PCNSL. Here, we present an unusual case of gradually progressing Parkinsonism with an elevation of cerebrospinal fluid (CSF) 14-3-3 protein and atypical imaging findings found to have PCNSL. A 76-year-old female patient presented with gait and intermittent speech difficulty. Initial workup revealed a contrast-enhancing lesion in the bilateral putamen and head of caudate without any mass effect. Her symptoms were rapidly progressed over 6 months and presented with mild dysarthria, bradykinesia, mild rigidity, and reduced left arm swinging. These features were consistent with Parkinsonism. The repeat imaging showed the progression of hyperintensities in the bilateral putamen. The patient underwent a stereotypic biopsy of the right caudate nucleus, which revealed PCNSL. She was treated with high-dose methotrexate and is currently in remission. Diagnosis of movement disorders remains clinical and rapid progression of symptoms, and atypical presentation must warrant further imaging and workup.
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Nagarajan et al. (2020) conducted a case report in Primary central nervous system lymphoma (n=1). High-dose methotrexate was evaluated. A 76-year-old female with rapidly progressing Parkinsonism was diagnosed with primary central nervous system lymphoma and achieved remission following treatment with high-dose methotrexate.
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