Twice Bitten, Once Shy

Fatigue, Confusion; HeadacheA 57-year old female with fatigue, confusion and headache associated with a right inferior quadrantanopsia.Right-sided hemiparesis and dysarthriaCT; MRILarge perivascular malignant lymphoid cellsIV Corticosteroids; Antineoplastic antimetabolites; Vitamin B complex1. Liu C, Lin C. Diagnosis of Primary CNS Lymphoma. J Med Sci 2009;29(3):155-158. 2. Brecher K, Hochberg F, David lH, et al. Case report of unusual leukoencephalopathy preceding primary CNS lymphoma. J Neurol Neurosurg Psychiatry 1998;65:917-920. 3. Alderson L, Fetell MR, Sisti M, et al. Sentinel lesions of primary CNS lymphoma. Journal of Neurology, Neurosurgery, and Psychiatry 1996;60:102-105. 4. Kuhlmann T, Schroter A, Dechent P, et al. Diagnosis of a multifocal B cell lymphoma with preceding demyelinating central nervous system lesions by single voxel proton MR spectroscopy. J Neurol Neurosurg Psychiatry 2001;70:259-262