Symptoms of Lymphoma in the Brain
The most common neurological symptoms of brain lymphoma are focal deficits (70%; including hemiparesis and ataxia), neuropsychiatric symptoms or personality changes (43%), signs of high intracranial pressure (33%), and seizures (14%). 1
Primary Central Nervous System Lymphoma (PCNSL) Symptoms
Common Neurological Manifestations
- Focal neurological deficits (70%) - including weakness on one side of the body (hemiparesis) and problems with coordination (ataxia) 1
- Neuropsychiatric symptoms or personality changes (43%) - including altered mental status and behavioral changes 1
- Signs of high intracranial pressure (33%) - often presenting as headache 1
- Seizures (14%) - though these occur relatively rarely compared to other brain tumors 1
- Cognitive dysfunction - including confusion, memory problems, and lethargy 1
- Headache - often persistent and progressive 1
Less Common Manifestations
- Visual disturbances - particularly when there is ocular involvement 1
- Cranial nerve palsies - especially involving facial or oculomotor nerves 1
- Hearing loss - particularly with meningeal involvement 1
Symptom Patterns Based on Location
The clinical presentation varies depending on the specific location of lymphoma in the brain:
- Frontal lobe and brain hemispheres (38% of cases) - personality changes, cognitive decline, and motor deficits 1
- Thalamus or basal ganglia (16%) - sensory deficits, movement disorders 1
- Corpus callosum (14%) - disconnection syndromes, cognitive issues 1
- Periventricular regions (12%) - often associated with hydrocephalus symptoms 1
- Cerebellum (9%) - ataxia, coordination problems, dizziness 1
- Meningeal involvement (16%) - headache, neck stiffness, cranial nerve palsies 1
Bing-Neel Syndrome (CNS involvement in Waldenström's Macroglobulinemia)
Bing-Neel syndrome is a rare manifestation of Waldenström's macroglobulinemia with CNS involvement, presenting with:
- Headache, nausea, and vomiting 1
- Visual disturbances and hearing loss 1
- Cranial neuropathies (especially facial and oculomotor) 1
- Seizures and cognitive decline 1
- Aphasia and psychiatric symptoms 1
- Cerebellar dysfunction and paresis 1
Cognitive Impact
Cognitive impairment is a significant manifestation of brain lymphoma:
- Memory deficits - both verbal and non-verbal 1
- Attention problems - including reduced concentration 1
- Executive function impairment - affecting planning and decision-making 1
- Processing speed reduction - slowed cognitive responses 1
- Working memory deficits - difficulty holding information temporarily 1
Important Clinical Considerations
Diagnostic Challenges
- Symptoms may develop gradually over weeks to months, often leading to delayed diagnosis 1
- Brain lymphoma can mimic other neurological conditions, including demyelinating disorders 2
- Cognitive decline may be the predominant presenting symptom in up to 33.4% of cases 3
Prognostic Factors
- Preoperative clinical status is the most important factor determining prognosis 3
- Neurological symptoms often worsen with disease progression 4
- Long-term survivors may experience late neurotoxicity, particularly those who received whole brain radiation therapy 4
Red Flags for Urgent Evaluation
- Rapid progression of neurological symptoms 2, 3
- New-onset seizures in adults 1
- Progressive cognitive decline without clear etiology 1, 3
- Multiple focal neurological deficits developing over a short time period 1, 3
Early recognition of these symptoms is crucial for prompt diagnosis and treatment, as delays can significantly impact morbidity and mortality outcomes in patients with brain lymphoma 1, 3.