Primary cerebral lymphoma presenting as steroid-responsive chiasmal syndrome

A case of multiple primary cerebral lymphoma presenting with bitemporal hemianopsia due to a large suprasellar lesion is described; the visual symptoms improved after corticosteroid treatment. Involvement of the optic pathways is very unusual in primary central nervous system lymphomas; the visual symptoms can be due to lymphomatous uveitis or to infiltration of the optic nerves by leptomeningeal lymphoma, whereas bitemporal hemianopsia due to chiasmal compression has not been reported as first symptom of a cerebral lymphoma. The CT finding of multiple hyperdense well-enhanced lesions and their symmetrical distribution in the basal ganglia and frontal horns suggest the diagnosis of lymphoma. Improvement of neurological deficits during corticosteroid treatment is another feature typical of cerebral lymphomas.