Case Report Intravascular Lymphoma with Progressive CNS Hemorrhage and Multiple Dissections Ricky Chen , 1 Gurjeet Singh, 2 J. Scott McNally , 3 Cheryl A. Palmer , 4 and Adam de Havenon 5 1 Providence Brain & Spine Institute, Providence St. Vincent Medical Center, 9135 SW Barnes Road, Suite 461, Portland, OR 97225, USA 2 Legacy Medical Group Neurology, Salmon Creek Medical Center, 2121 NE 139th St., Suite 205 Medical Office Building A, Vancouver, WA 98686, USA 3 Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E, Salt Lake City, UT 84132, USA 4 Department of Pathology, University of Utah, Huntsman Cancer Institute, 2000 Circle of Hope Dr., Salt Lake City, UT 84112, USA 5 Department of Neurology, University of Utah, 175 N Medical Dr., Salt Lake City, UT 84132, USA Correspondence should be addressed to Ricky Chen; ricky.chen2@providence.org Received 25 June 2019; Revised 22 August 2019; Accepted 10 September 2019; Published 10 January 2020 Academic Editor: Isabella Laura Simone Copyright © 2020 Ricky Chen et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Intravascular lymphoma (IVL) is an uncommon and oſten fatal disease characterized by intraluminal proliferation of lymphomatous cells within blood vessels. Because of a heterogeneous clinical presentation and lack of sensitive diagnostic protocols, diagnosis of IVL is most oſten made at autopsy. However, with early diagnosis and appropriate chemotherapy, the prognosis is greatly improved and complete remission is possible. In order to broaden the possible presentations of IVL, we present a patient with an atypical manifestation of biopsy-proven intravascular large B-cell lymphoma who suffered dissections of both intracranial and extracranial arteries in addition to progressive intracranial hemorrhages. Case Report. A 47-year-old woman presented with unilateral paresthesias. She developed progressive multifocal infarcts and hemorrhage with dissections of both intracranial and extracranial arteries, resulting in coma. Brain biopsy revealed IVL. She received aggressive chemotherapy and remains in complete remission with good neurologic recovery. Conclusion. IVL is known to exert its pathology on small arteries and capillaries, but is not known to cause dissections of large vessels. e diagnosis should be considered in cases with unexplained arterial dissections and progressive strokes. Early diagnosis with appropriate laboratory screening and tissue confirmation by biopsy can lead to greatly improved outcomes. 1. Introduction Intravascular lymphoma (IVL) is recognized by the World Health Organization (WHO) as an extremely rare subtype of diffuse extranodal large B-cell non-Hodgkin’s lymphoma with an estimated annual incidence of 0.5 cases per 1,000,000 [1]. IVL leads to intraluminal proliferation of neoplastic lymphoid cells in small and medium vessels [2]. ese cells have lost the ability for transvascular migration due to defects in adhesion molecules [3]. IVL can involve any organ system, particularly the central nervous system (CNS), and its protean neurological manifestations oſten hinder diagnosis. Patients can present with subacute encephalopathy or dementia, paralysis, seizures, or multifocal cerebrovascular events, by order of frequency [1, 4, 5]. Systemic symptoms vary, but fever and skin lesions are the most common, whereas lymphadenopathy is usually absent [2]. Serologic abnormalities include anemia (63%), high lac- tate dehydrogenase (LDH) (82%) and beta 2-microglobulin levels (86%) [6]. Bone marrow involvement occurs in 32% of patients, and cerebrospinal fluid (CSF) rarely contains malig- nant cells [6]. Magnetic resonance imaging (MRI) is nonspe- cific and can be normal, though there are numerous reports of rapid progression of cerebral infarcts [5]. Organ biopsy is the gold standard for diagnosis of IVL but is frequently per- formed too late, and cases with CNS involvement are most Hindawi Case Reports in Neurological Medicine Volume 2020, Article ID 6134830, 7 pages https://doi.org/10.1155/2020/6134830