63-year-old healthy Caucasian female developed left facial weakness and shooting-pain 3 months before presentation which was treated with prednisone and valacyclovir for one week without improvement. She developed binocular diplopia and progressive dysphagia before admission. Exam: Left eye demonstrated downward exotropia with dilated and fixed pupil, decreased pinprick sensation with droopy on the whole left face, uvula deviated to right. Laboratory test including TSH, Hemoglobin A1c, ANA, ACE, syphilis, hepatitis and HIV screen were normal. MRI brain with contrast showed left 7th nerve enhancement from canalicular portion to the stylomastoid foramen and enhancement of left Meckel cavity. MRI C-T-L spine and CT chest-abdominal-pelvis were unremarkable. CSF showed normal protein, glucose and white count was 4/ul. CSF meningitis/encephalitis PCR, fungal culture, histoplasma and toxoplasma antibody, cryptococcal antigen, VDRL, ACE, MS penal, NMO antibody and paraneoplastic panel were negative. High volume CSF flow cytometry were repeated for three consecutive times; However, all came back as inadequate cell recovery although morphology consists with large atypical cell highly suspicious for malignancy favoring lymphoma. B-cell-receptor IgH-Gene-Rearragnement was negative. Since lesions were within cranial nerves, biopsy may result in permanent neurological dysfunction. Empiric chemotherapy was started after thorough discussion. After 3 cycles of MATRIX, her symptoms significantly improved. Repeated MRI two months later showed resolution of previous enhancement and as of this writing there is no evidence of lymphoma recurrence.