Highly malignant primary Burkitt-type B-cell lymphoma

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.