RIGHT FRONTAL HAEMORRHAGE ON IMAGING

Primary CNS Lymphoma is rare aggressive malignancy that ori-ginates entirely in the central nervous system. It represents a diagnostic challenge to clinicians as symptoms are frequently non–specific, and overall represents 4 % of intracranial neo-plasms.1 Cerebral amyloid angiopathy is characterised patho-logically by deposition of amyloid in small and medium vessels arteries of the cortex and leptomeninges. It is usually restricted to the leptomeninges and grey matter and stops abruptly when a perforating vessel reaches the junction of the cortex and subcor-tex. This explains why the haemorrhages are almost always lobar, CAA Makes vessels fragile and more likely to rupture.2 We present a case that has not been reported in previous lit-erature of an 82 year old man first seen in clinic with probable transient ischemic attacks secondary to a heavily calcified right ICA in October 2012. Magnetic Resonance demonstrated a size-able area of old hemorrhage in the right frontal lobe, and he discharged with clopidogrel. However he represented In December 2012 on three occasions over the course of a week with similar symptoms of left arm weakness and facial droop. Repeat MRI illustrated no new infarcts but a further hemor-rhage in the right frontal region just caudal to the previous hem-orrhage which has resolved. Further collateral revealed a 1 year history of cognitive decline and rapid deterioration in mobility since September 2012. Given the diagnostic uncertainty, an open right frontal biopsy was performed by the neurosurgeons. Histopathology demonstrated brain tissue with a focal infiltrate with large lymphoid cells with conspicuous nucleoli and a diffuse growth pattern consistent with a high grade CNS lymphoma