7/27/2010 Case 2

Presented by: Dr. Roy Rhodes - Robert Wood Johnson Medical School

Clinical History:

This 75-year-old man was admitted in January, 2009, with rapid-onset encephalopathy that resolved. Neurologic examination showed no residual problems, and cerebral angiography and CT were normal. Subsequently, non-Hodgkin's lymphoma was diagnosed and chemotherapy was given later in 2009. In March, 2010, the patient was suddenly confused and unsteady. He was again admitted to the hospital where he was soon aphasic. Lumbar puncture revealed increased protein in otherwise acellular CSF. Brain MRI was normal. Later, a CT scan showed foci of pontine calcification. Diagnosis and treatment options were discussed with the neurologist, who contacted the facility where the patient had been sent with his deepening encephalopathy. A specific low-toxicity treatment option based on a speculative diagnosis was suggested and then it was carried out at that facility. The neurologist reported in June, 2010, that the patient had a recovery to his previous "sharp" mental state. The neurologist wondered if the recovery was related to therapy, or if it might be spontaneous as it had seemed to be in the first instance in 2009. Options were discussed, and it was decided that CSF and blood for further studies would be collected if there were any recurrence, and that specifics of history and laboratory findings would be collected if a diagnosis could be proved.

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