TY - JOUR T1 - Surgical solution for a paraneoplastic neurodegenerative disorder JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2022-000928 VL - 7 IS - 1 SP - e000928 AU - Huda Muhammad AU - Daniel G Strayve AU - Raja R Narayan AU - Douglas W Blayney AU - Daniel Delitto Y1 - 2022/05/01 UR - http://tsaco.bmj.com/content/7/1/e000928.abstract N2 - A 58-year-old man with a history of obesity status post Roux-en-Y gastric bypass and chronic lymphocytic leukemia (CLL) with aggressive features in complete remission 10 months after bendamustine and rituximab chemotherapy presented with neurological decline. He previously was a high-functioning information technology expert who 3 weeks earlier began having difficulty with fine movement when using his mobile device. He presented at a local hospital with new-onset dysarthria and word-finding difficulties, prompting admission. He underwent extensive neurological workup, which was negative. He was given an empiric trial of steroids due to suspicion of a neurological paraneoplastic syndrome and had minimal improvement. Cross-sectional imaging of the chest, abdomen, and pelvis showed splenomegaly, with no other lesions or lymphadenopathy. He was transferred to our referral center for further management.He presented with white blood cell count of 3.1, hemoglobin of 11.5 g/L, and platelet count of 53,000/uL. An fluorodeoxyglucose (FDG)-positron emission tomography (PET) scan was notable only for high metabolic activity in the superior pole of the spleen, concerning for recurrent lymphoma (figure 1). We suspected transformation of CLL into diffuse large B cell lymphoma (DLBCL) (ie, Richter’s syndrome) with accompanying paraneoplastic manifestations. On initial evaluation by the surgical team, he was alert and oriented but … ER -