Central nervous system (CNS) lymphoma manifests as a highly aggressive non-Hodgkins lymphoma, either confined to the central nervous system or secondary to spread of systemic diffuse large B cell lymphoma. Presentation depends on the burden and location of disease, with a varying spectrum of symptoms ranging from headaches and cognitive changes to focal neurological deficits, seizures and neuropsychiatric symptoms.

Nineteen out of 136 patients (14%) were noted to have primarily neuropsychiatric symptoms leading to diagnosis of CNS lymphoma. Symptom onset to diagnosis ranged from 3 weeks to 11 months. The average age was 65, and 47% of subjects were male. Depression, apathy, agitation and features of parkinsonism were the most common neuropsychiatric symptoms identified, with psychosis and disinhibition being the least frequent. The majority had frontal lobe lesions (42%),  several had multifocal disease. Parkinsonian features were observed in 5 patients (26%). The associated lesions were mostly deep basal ganglia or corpus callosum. Notably, all patients had resolution of their parkinsonism with treatment of the lymphoma.

Neuropsychiatric symptoms are a rare but noteworthy presentation of CNS lymphoma, distinct from cognitive changes that have been previously described with this condition. There is an increasing awareness of neurological illness presenting as pure psychiatric disturbance, prompting exclusion of organic disease, particularly in elderly patients who present with new psychiatric complaints.