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A 92 year old woman was admitted with generalised convulsive status epilepticus. Although antiepileptic treatment was initiated the patient never regained consciousness and died 3 weeks after admission.
Brain CT showed multiple contrast enhancing nodules within the ventricular wall (figure, A and B). The periventricular location of the lesions could be confirmed macroscopically (figure C). Histopathology showed diffuse infiltrates of neoplastic lymphocytes, predominantly centroblasts, with several small necrotic areas (figure D) leading to the diagnosis of a diffuse large B cell lymphoma. Space occupying lesions in the ventricular wall represent a challenging differential diagnosis which includes both neoplastic and inflammatory disorders such as cerebral lymphoma, metastatic carcinoma, gliomas (for example, subependymal giant cell astrocytoma), hamartoma in tuberous sclerosis, and germinoma, as well as tuberculosis, toxoplasmosis, neurocysticercosis, and sarcoidosis.