Symmetrical ventricular lesions in an adolescent male

Abstract

A previously healthy 17-year-old boy presented with a 1-month history of headache and vomiting and worsening scholastic performance. These symptoms worsened over the 2 weeks prior to admission, with accompanying visual obscurations and excessive drowsiness. There was no history of seizures or other focal neurological deficits. There was no other significant past medical history. His general examination was normal. There were no neurocutaneous markers. A poor attention span precluded proper cognitive assessment. His fundus examination revealed papilledema. The rest of his cranial nerve examination was normal. There were no motor or sensory deficits. There were no signs of meningeal irritation. He was evaluated with a plain and contrast-enhanced MRI (Fig. 1, Fig. 2) with diffusion-weighted and apparent diffusion coefficient sequences (Fig. 3).Fig. 2Axial (a) and (b) coronal T1-weighted contrast-enhanced MRI.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig. 3(a) Diffusion-weighted and (b) apparent diffusion coefficient map.View Large Image Figure ViewerDownload Hi-res image Download (PPT) A.GliomaB.EpendymomaC.LymphomaD.Germinoma Answer on page 1570. Symmetrical ventricular lesions in an adolescent maleJournal of Clinical NeuroscienceVol. 18Issue 11PreviewThis is an unusual clinico-radiological presentation of a non-Hodgkin’s B-cell type primary central nervous system (CNS) lymphoma. The typical presentation of this malignancy in the immunocompetent is in the sixth decade, with imaging showing mostly solitary lesions in the white or deep grey matter or subependymal regions or, less commonly, leptomeningeal involvement.1 In our patient, the intensity of the lesions on T1-weighted and T2-weighted sequences, the intense contrast enhancement and the restricted diffusion were typical of a primary CNS lymphoma, however the almost en-plaque like growth with a cast of the ventricles is uncommon. Full-Text PDF