A 42-year-old male presented to the emergency department following an episode of collapse associated with severe neck pain, nausea and vomiting. No seizure was witnessed on this presentation; however, his family described a similar episode 2 weeks earlier, which had been accompanied by a generalized tonic clonic seizure lasting 30 s. He gave no history of weight loss, fatigue or anorexia. Neurological examination was unremarkable. He was fully alert and orientated with no papilloedema. He had no cerebellar signs and was not ataxic. There were no signs of anaemia or lymphadenopathy. Gadolinium-enhanced MRI in the coronal (Fig. 1) and axial planes (Fig. 2) demonstrated a solitary enhancing vermian mass that caused hydrocephalus by aqueduct obstruction. The patient underwent an uneventful excision of this lesion via a midline posterior fossa craniotomy. Histological examination (Fig. 3) showed cerebellar tissue infiltrated by a partially necrotic tumour composed of densely packed, smallto mediumsized atypical lymphoid cells, many of which had irregular nuclear margins. Some of the tumour cells had vesicular nuclei and a prominent nucleolus. Mitotic figures were frequent. The cells were FIG. 1. Gadolinium-enhanced MRI in the coronal plane.
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