{
  "abstract": "Malignancy is a rare cause of rapid functional decline. We present a case report of an 87-year-old left-handed, previously independent female, presenting with a 2-month history of rapid functional decline with recurrent falls and mild cognitive slowing, requiring a wheelchair for mobility and hoist transfer. Her past medical history includes Grave’s disease with elective total thyroidectomy, chronic back pain and postural hypotension. Examination revealed mild rigidity bilaterally with some mild upper and lower limb symmetrical, pyramidal weakness. Initial MRI brain was normal. Subsequent MRI brain 1 month later, showed bilateral subcortical white matter changes reported as a CSF1r related leukoencephalopathy. Her mobility deteriorated to the point of being unable to stand with fluctuating consciousness and positive grasp reflex with hyperreflexia. A repeat MRI Brain showed progressive asymmetric white matter changes, involving the corticospinal tracts, with minimal contrast enhancement and diffusion restriction. An MRI spine was normal. Initial bloods for leukoencephalopathy were normal. A lumbar puncture revealed a mononuclear pleocytosis with hypoglycorrhachia and cytology eventually revealed a large B-cell lymphoma. Flow cytometry was normal. Whole body PET-scan was normal. She was commenced on high dose methotrexate chemotherapy but ceased due to side effects and offered palliative care. Lymphomatosis cerebri is a rare subtype of primary CNS and important differential in an older patient presenting with rapid functional and cognitive decline with asymmetric, white matter changes involving the corticospinal tracts on MRI. Of importance, cytology and flow cytometry can be normal in >50% of cases, necessitating a biopsy.",
  "authors": [
    {
      "affiliations": [
        "Neurology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia"
      ],
      "name": "Nikhil C Farias"
    },
    {
      "affiliations": [
        "Neurology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia"
      ],
      "name": "Nai Lai"
    },
    {
      "affiliations": [
        "Neurology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia"
      ],
      "name": "Soumya Ghosh"
    }
  ],
  "title": "3547 Lymphomatosis cerebri presenting with rapid functional decline",
  "uid": "6296a080-c2cd-5f8e-b5a4-0818b64f8c67"
}