Posterior fossa lymphoma with initial vertigo presentation

This study retrospectively reviewed our experience in the diagnosis of six patients with posterior fossa lymphoma during the past decade. Initial manifestation included vertigo in all patients (100%) and ataxia in 4 (67%), with a mean duration of 40 days. Audiometry revealed sensorineural hearing loss in five patients (83%). Gaze-evoked nystagmus was also noted in five patients (83%). Electronystagmography (ENG) showed multiple central signs, e.g., abnormal eye tracking test, abnormal optokinetic nystagmus test, abnormal caloric and/or visual suppression tests. MR imaging demonstrated single or multiple or diffuse enhanced mass lesions in the cerebellum and/or brainstem. Two patients received lumbar puncture for cytological examination of cerebrospinal fluid (CSF) which disclosed lymphoma cells, while the other four patients underwent craniotomy for tissue proof, and the histopathological study confirmed as lymphoma. Then, all patients underwent irradiation coupled with chemotherapy. At the close of this study, three patients died, two were lost and one was alive. Although rare, aggressive posterior fossa lymphoma should be kept in mind when seeing a patient with persistent vertigo and ataxia accompanied by multiple central signs in ENG examination. An MRI scan followed by CSF cytological examination or histopathological study may help to confirm the diagnosis.