Clinical manifestations

Symptoms and signs of CNS involvement are caused by either leptomeningeal or parenchymal infiltration and by CSF flow obstruction with a resulting increase in intracranial pressure. Table 18.8 summarizes the sites of CNS involvement, and Table 18.9 delineates the signs and symptoms described in a large series of CNS involvement by NHL. It is clear that in recent years parenchymal involvement has been recognized more frequently with the routine use of MRI for staging of the CNS disease. Parenchy-mal involvement may be present in more than 50% of patients with CNS disease, and this recognition has important therapeutic implications.

As the whole neuroaxis may be involved, symptoms and signs are variable, depending on the localization of tumor cells. Characteristically, there are symptoms and signs at several levels of the neuroaxis.

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