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A 63-year-old woman with no medical history presented with two weeks of personality changes and social withdrawal, ignoring family, friends, and work. There were no apparent hallucinations or delusions. Her son brought her for evaluation after she began having difficulty recalling personal information and family names.
On examination, the patient was awake but inattentive, with a flat affect and no spontaneous speech. With prompting, all components of her language were otherwise normal. Her concentration was poor, as was remote and working memory. Her examination was otherwise normal for cranial nerves, strength, sensation, coordination, balance, and gait. Magnetic resonance imaging of the brain showed a symmetric enhancing lesion in the bilateral frontal lobes and anterior corpus callosum (Figure 1).
Jordan JT, Plotkin S, Dietrich J. Magnetic Resonance Imaging Observations in Primary Central Nervous System Lymphoma. JAMA Neurol. 2014;71(7):918-919. doi:10.1001/jamaneurol.2014.70