Primary cranial vault lymphoma is an extremely rare finding. It should be considered in the differential diagnosis of scalp masses. Although the analysis of outcome of the reported cases is difficult because of the small number of occurrences of this entity and the variability of follow-up, a combination of surgery, radiotherapy, and chemotherapy seems to offer better outcomes.

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A 50-year-old right-handed woman had been suffering from intermittent bifrontal headache for almost 3 years. Six months before her admission, the headache increased gradually and then involved her whole head. In addition, she developed a tremor of the right hand and the head, loss of spontaneity, and unusual fatigue. There were no associated symptoms of nausea, diminished vision, or seizure. Her medical history was only remarkable for type 2 diabetes mellitus and there was no relevant family history.Neurological examination revealed slight right hemiparesis (4+/5) with hyperactive tendon reflexes, but without Babinski's sign. Moderate bradykinesia and muscle rigidity were found in the right limbs. Tremor was the most prominent symptom. There were no sensory deficits or cerebellar signs. Routine biologic tests results were normal.Brain computed tomography (CT) showed a hypo-dense lesion in the left cerebral hemisphere with some calcifications at the anterior part and midline shift to the right (Fig. 1). T1-weighted magnetic resonance imaging (MRI) demonstrated a large hypo-intense tumor in the left fronto-temporal area, hyperintense on T2-weighted MRI, and peripheric gadolinium enhancement (Figs. 2 and 3). The patient underwent a left frontopterional craniotomy approach. A huge white cystic tumor was identified in the left sylvian fissure. The cyst contained hair and a Fig 1.-Brain CT scan showed a hypo-dense lesion in the left cerebral hemisphere with some calcifications at the anterior part and midline shift to the right.

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