Bing–Neel syndrome presenting with bilateral lumbar radiculopathy: A case report of a rare clinical entity |
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| Institution: | 1. Department of Neurosurgery, General University Hospital of Larissa, Larissa, Greece;2. Department of Haematology, General University Hospital of Larissa, Larissa, Greece;3. Department of Radiology, General University Hospital of Larissa, Larissa, Greece;4. School of Medicine, University of Thessaly, Larissa, Greece;1. Department of Neurology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China;2. Department of Pharmacy, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China;3. Department of Emergency, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China;4. Pediatric Intensive Care Unit, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China;1. Angiología y Cirugía Vascular, Hospital Universitario Gómez Ulla, Madrid, España;2. Angiología y Cirugía Vascular, Hospital de Sanchinarro, HM Hospitales, Madrid, España;3. Departamento de Traumatología y Cirugía Ortopédica, Hospital Universitario Ramón y Cajal, Madrid, España;4. Departamento de Traumatología y Cirugía Ortopédica, Hospital Universitario Madrid Sanchinarro, Madrid, España;1. Servicio de Neurocirugía, Hospital General Universitario de Castellón, Castellón, España;2. Facultad de Ciencias de la Salud, Universidad Jaume I de Castellón, Castellón, España;3. Servicio de Anatomía Patológica, Hospital General Universitario de Castellón, Castellón, España;4. Ascires/Eresa, Castellón, España;5. Servicio de Oncología Médica, Hospital Provincial de Castellón, Castellón, España;1. Servicio de Cirugía Plástica, Estética y Reparadora, Hospital Universitario La Zarzuela, Madrid, Comunidad de Madrid, España;2. Servicio de Radiodiagnóstico, Hospital Universitario Infanta Cristina, Parla, Comunidad de Madrid, España |
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| Abstract: | 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 420 mg 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. |
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| Keywords: | Bing–Neel syndrome Waldenstrom macroglobulinemia Walking difficulty Central nervous system CSF analysis Síndrome de Bing-Neel Macroglobulinemia de Waldenström Dificultades al caminar Sistema nervioso central Análisis de LCR |
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