Comment and Response |

Diagnosis of Intravascular Lymphoma—Reply

John J. Konikkara, MD1; Osvaldo H. Perurena, MD2
[+] Author Affiliations
1Department of Neurology, University of Texas Southwestern Medical Center, Dallas
2University of Texas Southwestern, Austin
JAMA Neurol. 2013;70(7):941-942. doi:10.1001/jamaneurol.2013.2973.
Text Size: A A A
Published online


In Reply We agree with Roohi’s opinion that in today’s era, medical decision making is strongly influenced by neuroimaging. However, we believe that it helps achieve a high level of diagnostic certainty in complex neurological situations.

Unfortunately, our patient had one of the rare neoplastic disorders affecting multiple organ systems and which typically presents with confounding the clinical picture and nonspecific laboratory and imaging findings.1 It has to be mentioned that approximately 50% to 80% of the cases are diagnosed only after autopsy, and many of the antemortem diagnoses are made incidentally in biopsies performed for different reasons.24 Most of the cases reported in the literature are postmortem evaluations or are diagnosed after a biopsy.5,6 Most likely, this condition is underdiagnosed. This is not an excuse for why we did not diagnose this patient’s condition. As we mentioned in the article, our approach to diagnosing a presumed systemic condition was based on the clinical, blood workup, cerebrospinal fluid, bone marrow biopsy, imaging, and brain biopsy findings, all of which were nonspecific but mimicked acute disseminated encephalomyelitis.


Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview





July 1, 2013
Fereydoon Roohi, MD
1SUNY Downstate Medical Center, University Hospital of Brooklyn at Long Island College Hospital, Brooklyn, New York
JAMA Neurol. 2013;70(7):941. doi:10.1001/jamaneurol.2013.307.
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Related Topics