Primary leptomeningeal lymphoma (PLML) is a rare entity, representing 7% of all cases of primary
central nervous system lymphoma and approximately 0.1% of primary central nervous system
tumours.1-4 Patients can present with symptoms of raised intracranial pressure, or cranial or spinal
polyradiculopathies.1-3 Even with extensive investigations, diagnosis in up to a third of patients can only
be confirmed with meningeal biopsy. In this Imaging Highlights, we describe a patient who presented
with multiple cranial nerve palsies with corresponding MRI nerve enhancement, and subsequent
meningeal biopsy proven lymphoma.