Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 56, Num. 4, 2008, pp. 485-486

Neurology India, Vol. 56, No. 4, October-December, 2008, pp. 485-486

Letter To Editor

MRI diagnosis of neurolymphomatosis of the brachial plexus

Arti Chaturvedi, J. P. Singh, Vikas Rastogi

Department of Radiodiagnosis, Command Hospital Air Force, Bangalore, India

Correspondence Address: Department of Radiodiagnosis, Command Hospital Air Force, Bangalore, India

docarti@gmail.com

Date of Acceptance: 05-Sep-2008

Code Number: ni08116

Sir,

Neurolymphomatosis (NL) is a rare manifestation of lymphoma which is characterized by selective infiltration of cranial and peripheral nerves and roots by lymphoma cells. ^[1] We present the classical magnetic resonance imaging (MRI) findings of brachial plexopathy in a 15-year-old boy with Non-Hodgkin's Lymphoma (NHL) who presented with right arm weakness six months after complete remission.

MRI of the brachial plexus demonstrated thickening and hyperintensity of the C5 root and upper trunk of the right brachial plexus. There was also hyperintensity of the adjacent spinal cord [Figure 1A and B]. Post Gadolinium images showed significant contrast enhancement of the involved trunk, nerve root and the spinal cord at C4-5 level [Figure - 2] and [Figure - 3]. A concomitant CSF examination revealed the presence of multiple, abnormal B-cell lymphocytes. In view of these typical MRI and CSF findings, a diagnosis of B-cell neurolymphomatosis involving the right brachial plexus was made and the patient was started on salvage chemotherapy.

Patients of NL commonly present with a progressive sensorimotor peripheral neuropathy, plexopathy or cranial neuropathy. A histopathological demonstration of malignant lymphocytes in the peripheral nerves is the gold standard for diagnosis but a biopsy may not always be possible or positive. ^[2] In such situations, MRI can be of immense diagnostic value by demonstrating diffuse neural thickening and enhancement and thus enabling an early diagnosis of NL. ^[1],[3]

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