Abstract
Hodgkin's lymphoma is a hematolymphoid neoplasm, primarily of B cell lineage, that has unique histologic, immunophenotypic, and clinical features. Neurologic complications of Hodgkin's Lymphoma can be separated into those that result directly from the disease, indirectly from the disease, or from its treatment. Direct neurologic dysfunction from Hodgkin's Lymphoma results from metastatic intracranial spinal disease, epidural metastases causing spinal cord/cauda equina compression, leptomeningeal metastases, or intradural intramedullary spinal cord metastases. Indirect neurologic dysfunction may be caused by paraneoplastic disorders (such as paraneoplastic cerebellar degeneration or limbic encephalitis) and primary angiitis of the central nervous system. Hodgkin's lymphoma treatment typically includes chemotherapy or radiotherapy with potential treatment-related complications affecting the nervous system. Neurologic complications resulting from mantle-field radiotherapy include the “dropped head syndrome,” acute brachial plexopathy, and transient ischemic attacks/cerebral infarcts. Chemotherapy for Hodgkin's lymphoma may cause cerebral infarction (due to emboli from anthracycline-induced cardiomyopathy) and peripheral neuropathy.
Highlights
Hodgkin’s lymphoma (HL) is a hematolymphoid neoplasm, primarily of B cell linage, that has unique histologic, immunophenotypic, and clinical features
Cerebrospinal fluid (CSF) dissemination of HL similar to neoplastic meningitis due to other cancers is characterized by multifocal signs and symptoms affecting the brain, cranial nerves, and spine and exiting nerve roots
No standard treatment exists for leptomeningeal HL, but similar to other causes of lymphomatous meningitis, intra-CSF chemotherapy may provide palliation in conjunction with involved-field radiotherapy [13, 20, 21]
Summary
Hodgkin’s lymphoma (HL) (previously termed Hodgkin’s disease) is a hematolymphoid neoplasm, primarily of B cell linage, that has unique histologic, immunophenotypic, and clinical features. Neurologic complications from HL or its treatment are rare, there are several unique disorders that may be seen and are clinically recognizable (Algorithm 1). The neurologic disorders related to HL can be separated into those that result directly from HL, that is, metastatic complications, indirectly from HL, or from HL-directed treatment. Treatment of these various disorders is not standardized due to the rarity of HL-related neurologic disorders, and management of these disorders reflects treatment for similar disorders occurring in other more common cancers
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