Images Dural based tumor causing cognitive decline: Answer Carlos Candanedo a , Andrew H. Kaye a,b , Samuel Moscovici a,⇑ a Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel b Department of Surgery, The University of Melbourne, Parkville, VIC, Australia 1. Answer C. Primary dural based lymphomas 2. Discussion Brain MRI (Fig. 1C-F in Question) showed two gadolinium- enhanced parasagittal lesions, one of them with significant sur- rounding brain edema. None of the differential diagnosis could be excluded based on imaging. Multiple parasagittal meningiomas was considered the proba- ble preoperative diagnosis. A gross total removal of a bilateral fron- tal parasagittal lesion was performed following craniotomy. The tumor was found to be soft, grey color, moderate vascular and firmly attached to the brain cortex and underlying white matter without any clean plane. The anterior part of the superior sagittal sinus was completely occluded and consequently was ligated and resected, including the tumor-involved falx. The left parietal parasagittal lesion was considered for follow-up and further treat- ment. There were no surgical or early postoperative complications. Patient was discharge six days after the surgery without any new neurological deficit. The pathology was a low grade B cell lymphoproliferative dis- ease. The immunohistochemical profile was equivocal, and thus exact subtyping was precluded. The differential diagnosis was between marginal zone lymphoma (MZL), small lymphocytic lym- phoma and diffuse type of grade I follicular lymphoma. Fig. 1. Preoperative (A) non-contrast and (B) contrast head CT, (C, D) axial, (E) sagittal T1-weighted gadolinium-enhanced and (F) axial fluid-attenuated inversion recovery (FLAIR) MRI showing multiple contrast-enhancing parasagittal lesions in a 73-year-old woman with significant surrounding brain edema. https://doi.org/10.1016/j.jocn.2019.10.019 0967-5868/Ó 2019 Elsevier Ltd. All rights reserved. DOI of question: https://doi.org/10.1016/j.jocn.2019.10.016 ⇑ Corresponding author at: Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem 91120, Israel. E-mail addresses: andrewk@hadassah.org.il (A.H. Kaye), samuelmoscovici@hotmail.com (S. Moscovici). Journal of Clinical Neuroscience 72 (2020) 493–494 Contents lists available at ScienceDirect Journal of Clinical Neuroscience journal homepage: www.elsevier.com/locate/jocn