Ziauddin.
Primary cerebral Lymphoma.
J Postgrad Med Inst Jan ;17(1):133-6.

A 60 years old lady was referred from a peripheral hospital because of weakness of left half of her body. Her daughter narrated that she has been increasingly forgetful over the past couple of months. She had been under the treatment of Psychiatrist and was on regular antidepressants. She had a past medical history of jaundice (1994) with uneventful recovery. On neurological examination, she had a mini mental score of 8/10. Cranial Nerves examination including fundoscopy was normal. There were no signs of meningism. She had left sided upper neuron type of weakness. There was no sensory neurological deficit. Cardiovascular, abdominal and chest examination was unremarkable. Initial investigations including full blood count and urinalysis were normal. ESR was raised at 65 mm in first hour. Biochemical profile including glucose, urea, creatinine, electrolytes and liver function tests were normal. Chest X-ray was normal. CT scan of brain revealed isodense mass in the left basal ganglion which showed enhancement after intravenous contrast administration without surrounding oedema, consistent with cerebral lymphoma. CSF examination showed lymphocytic pleocytosis. CT scan of abdomen revealed no systemic involvement. Initially she was treated with dexamethasone 4 mg six hourly for seven days. A follow up CT scan brain was performed on seventh day, which showed disappearance of the lesion, thus further conforming the diagnosis of cerebral lymphoma. Her case was further discussed with Oncologist and Neurosurgeon and the option of treatment with intravenous methotrexate was considered. But the family did not want any form of further active treatment. She was then discharged on steroids.

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