Content area
Full Text
Abstract: Primary central nervous system (CNS) lymphomas are an uncommon form of brain neoplasm that should be considered in the immunocompromised patient with neurological changes. It can be difficult to distinguish primary CNS lymphoma from stroke on initial radiographic images. Neuroscience nurses who are involved in the care of these patients should be prepared to assist the patient and family in coping with an evolving diagnosis and in explaining the related diagnostic procedures, treatment options, and eventual discharge plan.
When caring for immunocompromised patients who present with stroke symptoms, healthcare professionals need to consider the possibility of other disease processes, such as neoplasms, as the basis for neurological changes. Primary central nervous system (CNS) lymphoma accounts for only 3% of all intracranial neoplasms and 7% of all malignant lymphomas (Rowland, 2005). The incidence is more prevalent in adults ages 50 to 70 years, with a male-to-female ratio of 3:2 (Rowland). Single or multiple intraparenchymal lesions may occur. Clinical presentation may include headache, signs and symptoms of increased intracranial pressure, and lateralizing signs appropriate to the area(s) of involvement (Samuels & Feske, 1996). These symptoms can include behavioral, cognitive, and personality changes. Focal symptoms include hemiparesis, aphasia, and visual field defects. Ataxia, seizures, and cranial nerve palsies can also occur but are not as common (Hickey, 2002; Rowland).
Primary CNS lymphoma is a diffuse non-Hodgkin lymphoma typically of the intermediate- or highgrade variety. Diffuse large B-cell lymphoma is the most common type of lymphoma worldwide. The tumor cells tend to grow in the perivascular spaces, although they do not destroy or obliterate the vascular lumen (Samuels & Feske, 1996). Systemic dissemination of primary CNS lymphoma is rare. Regardless of where the malignant cells originate, once within the CNS, these cells proliferate in the subarachnoid space, the choroid plexus, or both and subsequently disseminate throughout the CNS (Shibata, 1989). Primary CNS lymphomas have a different appearance on computed tomography (CT) scan or magnetic resonance imaging (MRI), depending on whether the patient is immunocompetent or immunocompromised. In the immunocompetent patient, the lesion may appear as a solitary mass, but it may also take the form of multiple masses or a diffuse, infiltrating lesion. On CT or T2-weighted MRI, edema may be visible and surround the lymphoma...