A 40-year-old woman with a progressive periventricular white matter lesion.

摘要

A 40-year-old woman presented with blurred vision and diplopia, followed by slowly progressive left-sided motor and sensory disturbances. She also suffered from memory loss and mild spatial and temporal disorientation. A T2-weighted MRI (Figure 1 A) showed a large area of high signal intensity (indicated by arrows) in the periventricular white matter of the right more than the left occipital region and the corpus callosum, without enhancement on Tl-weighted images (Figure IB), There was no mass effect. A tumor was considered unlikely, and acute demyelinating encepha-lomyelopathy was suspected. Repeated cerebrospinal fluid (CSF) examinations showed a mononuclear pleocytosis (10 cells per cubic mm, normal value: <3 cells), without immunohistochemical evidence of tumor cells; tumor markers HCG, AFP and CEA were not elevated. Flow cytometry showed predominantly reactive T-lymphocytes, but again no evidence of tumor cells. CT scan of thorax and abdomen did not reveal any abnormalities. The CSF-serum IgG index was normal, and oligoclonal bands were absent. No evidence of a vasculitis or an inflammatory disease was found. Treatment with steroids proved ineffective.