The classical appearance of a homogeneous hyperdense periventricular space-occupying lesion (SOL) with subependymal extension along the ventricular system, demonstrating diffusion-weighted imaging (DWI) restriction and post-contrast homogeneous enhancement, is highly suggestive of primary CNS lymphoma.

This patient initially presented to our department in 2021, with lymphoma ranking high on the list of possible diagnoses. Subsequently, the patient was referred to a tertiary center where the final and definitive diagnosis was established. The patient returned to our trust in 2023, and imaging revealed the total resolution of the lesion, further supporting the likelihood of it being lymphoma.

A comprehensive scan of the entire neuroaxis (whole spine) has been performed to rule out drop metastasis, and the results were negative in this case.