Case 7: Chief Complaint: Paraplegia and Encephalopathy

Benjamin Greenberg, MD

In This Article

Further Work-up

The patient experienced worsening lower-extremity weakness, scoring 1 of 5 to 2 of 5. Angiogram found normal brain vasculature, but showed 1 lumbar spine vessel to be occluded.

Echocardiogram demonstrated an ejection fraction of 60%, with atherosclerotic changes of the aorta. Electroencephalogram (EEG) revealed diffuse cerebral disturbance with slowing. Computed tomographic (CT) scan of the chest, abdomen, and pelvis showed enlarged adrenal glands. A colonoscopy demonstrated 2 polyps (tubular adenomas), which were removed.

At this point a brain biopsy was performed (Figure 2).

Microscopic examination of frontal lobe biopsy demonstrates small blue cells filling a parenchymal arteriole (black arrow).

Based on the findings in Figure 2, what is your diagnosis?

  1. Myeloma

  2. Endocarditis

  3. Lupus

  4. Intravascular lymphomatosis

View the correct answer.


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