INTRAVASCULAR MALIGNANT LYMPHOMATOSIS WITH NEUROLOGIC PRESENTATION - FACTORS FACILITATING ANTEMORTEM DIAGNOSIS

Intravascular malignant lymphomatosis (IML) is a rare disorder of smal l aid medium size vessels that frequently goes undiagnosed until the t ime of autopsy The clinical courses of two such patients were examined to determine factors that would facilitate antemortem diagnosis. Both patients had mental status changes, pyramidal tract signs, and periph eral neuropathy, Despite postmortem evidence of widespread lymphocytic invasion of vessels throughout the body including peripheral and cent ral nervous systems, neuroimaging studies, cerebrospinal fluid analysi s, peripheral blood studies, and bone marrow biopsy failed to reveal d iagnostic evidence of the underlying neoplastic process, Although mark edly abnormal, nerve conduction studies were nonspecific, Familiarity with IR IL and its consideration in the differential diagnosis when ce ntral and peripheral nervous system dysfunction occur concurrently may guide the physician to tissue biopsy facilitating antemortem diagnosi s and institution of appropriate therapy.