Presentation
The patient presented with a headache for 6 weeks, progressively worsening day by day. The pain is more severe in the morning and when bending forward. There is also occasional neck pain, and the use of analgesics has been ineffective.
Patient Data
There is a homogeneous relatively hyperdense periventricular space-occupying lesion (SOL) involving the right frontal lobe, associated with surrounding vasogenic edema.
The lesion displays subependymal extension into both lateral ventricles, the third ventricle, and also extends to the fourth ventricle.
In the bone window there is accidentally seen left temporal bone lesion thought to be fibrous dysplasia or Pagetoid-related changes.
The MRI reveals a periventricular intra-axial space-occupying lesion (SOL) involving the right frontal lobe, associated with surrounding vasogenic edema.
The lesion demonstrates subependymal extension to both lateral ventricles, the third, and fourth ventricles.
It also shows an isointense signal to grey matter and significant diffusion restriction as a bright signal on DWI and a dark signal on the ADC map.
In the post-contrast series, the lesion exhibits homogeneous intense enhancement.
Non-contrast CT has been done after two years and after treatment reveals total resolution of the lesion.
Pre and post-contrast MRI has been done after two years and after treatment reveals total resolution of the lesion.
Case Discussion
The classical appearance of a homogeneous hyperdense periventricular space-occupying lesion (SOL) with subependymal extension along the ventricular system, demonstrating diffusion-weighted imaging (DWI) restriction and post-contrast homogeneous enhancement, is highly suggestive of primary CNS lymphoma.
This patient initially presented to our department in 2021, with lymphoma ranking high on the list of possible diagnoses. Subsequently, the patient was referred to a tertiary center where the final and definitive diagnosis was established. The patient returned to our trust in 2023, and imaging revealed the total resolution of the lesion, further supporting the likelihood of it being lymphoma.
A comprehensive scan of the entire neuroaxis (whole spine) has been performed to rule out drop metastasis, and the results were negative in this case.
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