scholarly journals A Case of the Cauda Equina Syndrome Associated With the Intrathecal Chemotherapy in a Patient With Primary Central Nervous System Lymphoma

2013 ◽  
Vol 37 (3) ◽  
pp. 420 ◽  
Author(s):  
Seunglee Park ◽  
Jung-Il Kang ◽  
Hyun Bang ◽  
Bo-Ram Kim ◽  
Jongmin Lee
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Central Nervous System Lymphoma ◽  
Intrathecal Chemotherapy

scholarly journals Surgical interventions for primary central nervous system lymphoma

2006 ◽  
Vol 21 (5) ◽  
pp. 1-8 ◽  
Author(s):  
James B. Elder ◽  
Thomas C. Chen
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Surgical Intervention ◽  
Central Nervous System Lymphoma ◽  
Intrathecal Chemotherapy ◽  
Surgical Decompression ◽  
Surgical Interventions ◽  
Leptomeningeal Involvement ◽  
Neurological Presentation

✓ Early diagnosis is central to proper management of primary central nervous system lymphomas (PCNSLs). Surgical intervention hinges on initial entertainment of a diagnosis of a PCNSL, based on acute neurological presentation and neuroimaging findings. Unless there is an urgent need for surgical decompression, a biopsy to obtain a diagnosis of PCNSL is the first step in surgical management. Repeated biopsy may be necessary in patients who have received pre-operative steroid therapy. Patients with PCNSL may also present with leptomeningeal involvement, resulting in the need for an Ommaya reservoir for intrathecal chemotherapy. In cases in which hydrocephalus develops, placement of a ventriculoperitoneal shunt may be necessary. Two case studies are presented to highlight the role of surgical intervention in PCNSL.

scholarly journals Successful treatment of central nervous system myeloma manifesting as cauda equina nodules with intrathecal chemotherapy, lenalidomide and dexamethasone

2018 ◽  
pp. bcr-2018-226146 ◽  
Author(s):  
Ray Mun Koo ◽  
Philip Crispin ◽  
Melissa Craft ◽  
Shivendra Lalloo
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Lower Limb ◽  
Plasma Cells ◽  
Cauda Equina ◽  
Intrathecal Chemotherapy ◽  
Dorsal Column ◽  
Hip Flexion ◽  
Multiple Episodes ◽  
Csf Examination

We report a case of central nervous system myeloma manifesting as cauda equina nodules, successfully treated with triple intrathecal (IT) chemotherapy, lenalidomide and dexamethasone. After presenting with multiple plasmacytomas which led to a diagnosis of non-secretory myeloma at age 56, the patient underwent multiple episodes of treatment for relapsing myeloma over a 7-year period. In March 2017, he presented with declining gait over a month with bilateral hip flexion weakness, absent lower limb reflexes and dorsal column loss. MRI of the spine revealed multiple enhancing cauda equina nodules at L1–L3. Cerebrospinal fluid (CSF) examination confirmed a clonal plasma cell population and disease was not found elsewhere. He was treated with radiotherapy, IT and intravenous methotrexate and cytarabine. However, repeat lumbar puncture revealed persistent disease. Clearance of CSF plasma cells was achieved with two times a week IT cytarabine, methotrexate and dexamethasone. He was started on lenalidomide and dexamethasone with no evidence of disease progression at 12 months.

scholarly journals NIMG-38. RECOGNIZING DISSEMINATED NECROTIZING LEUKOENCEPHALOPATHY IN LEPTOMENINGEAL CARCINOMATOSIS PATIENTS TREATED WITH INTRATHECAL METHOTREXATE VIA OMMAYA RESERVOIR AFTER WHOLE BRAIN IRRADIATION

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi169-vi169
Author(s):  
Andrew Conger ◽  
Thomas Scheeler ◽  
Erika Leese ◽  
Gino Mongelluzzo ◽  
Na Tosha Gatson
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Rare Complication ◽  
Central Nervous System Lymphoma ◽  
Leptomeningeal Carcinomatosis ◽  
Intrathecal Chemotherapy ◽  
Intrathecal Methotrexate ◽  
Whole Brain Irradiation ◽  
Whole Brain ◽  
Radiographic Findings

Abstract BACKGROUND Disseminated necrotizing leukoencephalopathy (DNL) is a rare complication of intrathecal (IT) methotrexate administration with a previously reported incidence of 2.8%1 in patients undergoing treatment for central nervous system leukemia or lymphoma. The purpose of this study is to estimate the incidence of DNL in a series of patients undergoing treatment for leptomeningeal carcinomatosis (LMC) and to better characterize the radiographic findings associated with DNL. METHODS A retrospective review of a prospectively gathered database of 36 LMC patients was conducted. Patients were treated with whole brain radiation and a standardized regimen of twice-weekly IT methotrexate in the context of an established IT chemotherapy clinic. Data regarding the patients’ primary cancer pathology, time from initiation of IT methotrexate to onset of DNL, and radiographic characteristics of DNL were collected. RESULTS Six of 36 patients (16.7%) developed DNL. Mean time from initiation of IT treatment to development of DNL was 6.7 months. Primary pathologies of the DNL patients were breast (3), melanoma (1), GI (1), and pancreatic neuroendocrine (1). Radiologic presentation included areas of T2 hyperintensity, T1 hypointensity with contrast-enhancement, and restricted diffusion, all consistent with acute demyelination. These radiographic changes predominantly involved the catheter tract, periventricular and deep white matter, and grey-white interface. Interpretation of the magnetic resonance imaging by radiologists was highly inaccurate with the findings interpreted as catheter infection, progression of metastatic disease, stroke, or “possible treatment effect”, but never correctly identified as DNL. CONCLUSION DNL is a rare complication of intrathecal chemotherapy but may have a higher incidence in patients undergoing aggressive management of LMC than in those being treated for central nervous system lymphoma or leukemia. Although the imaging in DNL often exhibits characteristic findings, the rarity of this pathology leads to frequent misinterpretation, potentially complicating management of LMC.

A Luetic Cauda Equina Meningoradiculitis Mimicking a Central Nervous System Lymphoma

2016 ◽  
Vol 43 (2) ◽  
pp. 122-124 ◽  
Author(s):  
Jacopo Monticelli ◽  
Gabriele Bazzocchi ◽  
Roberto Luzzati
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Cauda Equina ◽  
Central Nervous System Lymphoma

scholarly journals Successful BCMA CAR-T Therapy for Multiple Myeloma With Central Nervous System Involvement Manifesting as Cauda Equina Syndrome—A Wandering Road to Remission

2021 ◽  
Vol 11 ◽  
Author(s):  
Yiyun Wang ◽  
Linqin Wang ◽  
Yifan Zeng ◽  
Ruimin Hong ◽  
Cheng Zu ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Multiple Myeloma ◽  
T Cells ◽  
Nervous System ◽  
T Cell ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Cns Involvement ◽  
Car T Cells ◽  
Car T

Multiple myeloma (MM) with central nervous system (CNS) involvement is rare with only 1% incidence. So far, there is no standard or effective treatment for CNS MM, and the expected survival time is fewer than 6 months. Here, we report a case of MM with CNS involvement presented with cauda equina syndrome (CES) who achieved complete remission after anti-B-cell maturation antigen (BCMA) chimeric antigen receptor T (CAR-T) cell therapy (Chictr.org.cn, ChiCTR1800017404). The expansion of BCMA CAR-T cells was observed in both peripheral blood (PB) and cerebrospinal fluid (CSF). The CAR-T cells peaked at 2.4 × 106/l in CSF at day 8 and 4.1 × 109/l in PB at day 13. The peak concentration of interleukin (IL)-6 in CSF was detected 3 days earlier, and almost five times higher than that in PB. Next, morphological analysis confirmed the elimination of nucleated cells in CSF 1 month after CAR-T cell treatment from 300 cells/μl, and the patient achieved functional recovery with regressed lesion shown in PET-CT. The case demonstrated that BCMA CAR-T cells are effective and safe in this patient population.

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