History and clinical findings: A 40-year-old man was admitted with acute on
set of positional vertigo, nausea and vomiting. Neurological examination re
vealed a fatigable nystagmus to the upward ear in positional testing, to th
e right more than to the left, as well as latent paresis and rigidity of th
e left arm.
Investigations: Magnetic resonance imaging of the brain revealed two space-
occupying lesions in the cerebellum and pens. Open biopsy showed a highly m
alignant B-cell lymphoma of Burkitt type. There was no evidence of acquired
or congenital immunodeficiency. As there were no significant abnormalities
outside of the CNS, a primary lymphoma in this location was diagnosed.
Treatment and course: Chemotherapy with a combination of drugs including me
thotrexate achieved only partial remission. Subsequent radiotherapy brought
about full remission, which has now lasted for over a year.
Conclusions: Treatment of first choice of a primary cerebral lymphoma in an
immunocompetent patient is chemotherapy with cerebrospinal fluid-permeable
cytostatics. Partial remission should be followed by radiotherapy.