Nodular nerves and lumpy leptomeninges – neuroimaging in primary leptomeningeal lymphoma

Primary leptomeningeal lymphoma (PLML) is a rare entity, representing 7% of all cases of primary central nervous system lymphoma and approximately 0.1% of primary central nervous system tumours.1-4 Patients can present with symptoms of raised intracranial pressure, or cranial or spinal polyradiculopathies.1-3 Even with extensive investigations, diagnosis in up to a third of patients can only be confirmed with meningeal biopsy. In this Imaging Highlights, we describe a patient who presented with multiple cranial nerve palsies with corresponding MRI nerve enhancement, and subsequent meningeal biopsy proven lymphoma.