How is primary central nervous system lymphoma (PCNSL) differentiated from transverse myelitis?

Updated: Jan 19, 2018
  • Author: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Answer

Uncommonly, primary CNS lymphoma (PCNSL) can present as longitudinally extensive transverse myelopathy (LETM). Then the condition often mimics transverse myelitis. PCNSL may be noncontrast enhancing on gadolinium-enhanced MRI. Failure to suspect and evaluate leads to delay in diagnosis and treatment of LETM of PCNSL. CSF analysis should always be done in transverse myelitis before starting corticosteroids as is usual practice in this condition because steroids may lead to transient improvement and mask the correct diagnosis. Repeated CSF examinations may be needed to finalize the diagnosis of PCNSL or LETM of PCNSL. [13]


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