Bing–Neel syndrome presenting with bilateral lumbar radiculopathy: A case report of a rare clinical entity
| Autor: | Maria Palassopoulou, Alexandros G. Brotis, Thanos Paschalis, Eftychia Z. Kapsalaki, Konstantinos Fountas, Vassilis Papastergiou |
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| Rok vydání: | 2022 |
| Předmět: |
medicine.medical_specialty
Past medical history medicine.diagnostic_test business.industry Waldenstrom macroglobulinemia Physical examination Magnetic resonance imaging General Medicine medicine.disease 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine chemistry Serum protein electrophoresis Ibrutinib medicine Surgery Neurology (clinical) Radiology Differential diagnosis business 030217 neurology & neurosurgery Bing–Neel syndrome |
| Zdroj: | Neurocirugía (English Edition). 33:250-253 |
| ISSN: | 2529-8496 |
| DOI: | 10.1016/j.neucie.2021.03.004 |
| Popis: | The differential diagnosis of bilateral lower extremity weakness is broad. We present a very rare case of a 48-year old male patient, with walking difficulties due to Bing-Neel syndrome. On clinical examination, there was a significant loss of muscle power in all his lower extremities key-muscle groups. The lumbar spine magnetic resonance imaging (MRI) showed only mild degenerative changes, whereas the MRI of the head indicated a diffuse meningeal thickening at the right temporal region, characterized by significant enhancement after contrast administration. Serum protein electrophoresis detected an IgM-kappa monoclonal protein. The patient received intrathecal chemotherapy with methotrexate and cytarabine, and was started on oral ibrutinib 420mg daily. In conclusion, a past medical history of Waldenstrom macroglobulinemia in conjunction with neurological manifestations should alert the treating physician for Bing-Neel syndrome. A complete diagnostic imaging and serologic protocol helps in setting the final diagnosis. Steroids are part of the treatment, but should be given after the diagnosis is set. Neurosurgical intervention is indicated for histologic confirmation in the case of diagnostic uncertainty. |
| Databáze: | OpenAIRE |
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