Spinal cord infarct as the initial clinical presentation of intravascular malignant lymphomatosis

Intravascular malignant lymphomatosis (IML) is an extremely rare form of lymphoproliferative disorder that is characterized by proliferation of the lymphoma cells in the vascular lumens. We report on a 78-year-old man who initially presented with spinal cord infarct at the T11/12 level. Despite biopsies of the spinal cord and bone marrow from the sternum, the correct diagnosis was not made until autopsy. We identified 19 patients with IML showing spinal cord symptoms as the initial clinical manifestation, and considered the clinical and radiological characteristics as well as the limitations of biopsy. IML can be an important differential diagnosis of progressive paraparesis of unknown etiology.