An 80-year-old man, in remission from Waldenström macroglobulinemia (WM), presented with 6-month cognitive decline, broad-based shuffling gait, and nocturia. Serial CT head demonstrated progressive ventriculomegaly. MRI revealed abnormal fluid-attenuated inversion recovery signal in the lateral ventricles with fluid–fluid levels and in peripheral sulci/basal cisterns. Pachymeningeal thickening/enhancement was noted at the frontal dura, cavernous sinus, and Meckel caves (Figure). Spinal MRI revealed enhancement along the thoracic spinal cord/conus with a thickened cauda equina. Highly proteinaceous CSF (7.01 g/L) formed a jelly-like precipitate moments after lumbar puncture (Video 1). CSF white blood cell count was 27 x 10⁶/L (92% lymphocyte) and flow cytometric analysis confirmed recurrent CNS WM (Bing-Neel syndrome).^1,2

一名 80 岁男性，从 Waldenström 巨球蛋白血症 (WM) 中缓解，出现 6 个月的认知能力下降、广泛的拖曳步态和夜尿。系列 CT 头显示进行性脑室扩大。MRI 显示侧脑室液-液水平和外周脑沟/基底池异常的液体衰减倒置恢复信号。在额部硬脑膜、海绵窦和 Meckel 腔观察到硬脑膜增厚/增强（图）。脊柱 MRI 显示沿胸脊髓/圆锥增强，马尾神经增厚。高蛋白 CSF (7.01 g/L) 在腰椎穿刺后立即形成果冻状沉淀物（视频 1）。脑脊液白细胞计数为 27 x 10 ⁶/L（92% 淋巴细胞）和流式细胞仪分析证实复发性 CNS WM（Bing-Neel 综合征）。^1,2