Advertisement

Annals of Hematology

, Volume 91, Issue 3, pp 463–465 | Cite as

Paroxysmal non-kinesigenic dyskinesia due to spinal cord infiltration of low-grade B cell non-Hodgkin's lymphoma

  • Rudolf BenzEmail author
  • Andrea Viecelli
  • Christian Taverna
  • Ludwig Schelosky
Letter to the Editor

Dear Editor,

A 65-year-old female patient was referred to our clinic due to singultus, nausea and vomiting. Splenomegaly without lymphadenopathy was found. The remaining clinical examination and an MRI scan of the brain were normal. Bone marrow examination was morphologically unremarkable, but the light-chain scattergram in flow cytometry showed a significant B cell population which was double negative although a clear light-chain restriction indicating a clonal population was not present. We therefore planned a splenectomy for further diagnosis. However, the patient developed rapidly progressing symmetrical tetraparesis. A spinal MRI scan revealed an extensive intramedullary area of intense contrast enhancement on T1-weighted images, comprising the spinal cord from C1 downwards (Fig.  1a). A biopsy was not possible without a significant potential risk for irreversible neural damage. The cerebrospinal fluid (CSF) contained CD20-positive lymphocytes of lymphoplasmocytoid aspect...

Keywords

Pregabalin Levetiracetam Video Segment Liposomal Cytarabine Paroxysmal Dyskinesia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

We would like to thank Prof. Wentz for preparing the MRI images.

Supplementary material

Segment 1

Spontaneous involuntary adduction and flexion in the metacarpo-phalangeal joint of the left thumb, initially slight flexion and then extension in the interphalangeal joint of the thumb; slight flexion and abduction in the metacarpo-phalangeal joints and extension in the interphalangeal joints of the fingers. Voluntary pronation of the left hand to demonstrate the position of the thumb. The episode lasted 37 s and ceased spontaneously (MPG 35,440 kb)

Segment 2

Voluntary movements of the hands could not provoke dystonic posturing, but after 15 s of rest, a new dystonic episode starts in the left hand (MPG 50,287 kb)

References

  1. 1.
    Malkani RG, Tallman M, Gottardi-Littell N et al (2010) Bing-Neel syndrome: an illustrative case and a comprehensive review of the published literature. J Neurooncol 96:301–312PubMedCrossRefGoogle Scholar
  2. 2.
    Blakeley J, Jankovic J (2002) Secondary causes of paroxysmal dyskinesia. Adv Neurol 89:401–420PubMedGoogle Scholar
  3. 3.
    Riley DE (1996) Paroxysmal kinesigenic dystonia associated with a medullary lesion. Mov Disord 11:738–740PubMedCrossRefGoogle Scholar
  4. 4.
    Tan EK, Lo YL, Chan LL, See SJ, Hong A, Wong MC (2002) Cervical disc prolapse with cord compression presenting with choreoathetosis and dystonia. Neurology 58:661–662PubMedGoogle Scholar
  5. 5.
    Yulug B, Bakar M, Ozer HH, Yilmaz M, Unlü B (2008) Paroxysmal kinesigenic dyskinesia and cervical disc prolapse with cord compression: more than a coincidence? J Neuropsychiatry Clin Neurosci 20:237–239PubMedCrossRefGoogle Scholar
  6. 6.
    Sozzi G, Marotta P, Piatti L, Taborelli A, Dorizzi A (1987) Paroxysmal sensory-motor attacks due to a spinal cord lesion identified by MRI. J Neurol Neurosurg Psychiatry 50:490–492PubMedCrossRefGoogle Scholar
  7. 7.
    Cosentino C, Torres L, Flores M, Cuba JM (1996) Paroxysmal kinesigenic dystonia and spinal cord lesion. Mov Disord 11:453–455PubMedCrossRefGoogle Scholar
  8. 8.
    Jahnke K, Korfel A, O'Neill BP et al (2006) International study on low-grade primary central nervous system lymphoma. Ann Neurol 59:755–762PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Rudolf Benz
    • 1
    Email author
  • Andrea Viecelli
    • 2
  • Christian Taverna
    • 1
  • Ludwig Schelosky
    • 3
  1. 1.Clinic for Hematology and Oncology, Department of Internal MedicineKantonsspital MünsterlingenMünsterlingenSwitzerland
  2. 2.Fremantle Hospital and Health ServiceFremantleAustralia
  3. 3.Clinic for Neurology, Department of Internal MedicineKantonsspital MünsterlingenMünsterlingenSwitzerland

Personalised recommendations