CASE REPORT Palinopsia as the initial manifestation of non-hodgkin’s lymphoma Mohammed Ziaei • Mostafa A. Elgohary • Fion D. Bremner Received: 13 August 2012 / Accepted: 19 November 2012 / Published online: 29 November 2012 Ó Springer Science+Business Media Dordrecht 2012 Abstract A 37-year old general practitioner thought to be in good health presented to the ophthalmology department with palinopsia, headaches and transient visual obscurations. A CT scan revealed a large destructive lesion centred on the occiput and stealth guided excisional biopsy of the occipital lesion showed diffuse large B cell, Non-Hodgkin’s lym- phoma (NHL) infiltration. To the best of our knowl- edge this is only the second report of a patient with NHL presenting with palinopsia. Keywords Haematological malignancy Á Non- hodgkin’s lymphoma Á Palinopsia Case report A 37-year old general practitioner thought to be in good health complained of palinopsia (‘‘after attending church, wherever I looked, the spires of the cathedral appeared overlying everything’’) and transient visual obscurations associated with severe dull bitemporal headaches, vertigo and nausea. Assessment of his vision showed acuities of 6/9 in both eyes and normal colour vision (tested using Ishihara pseudoisochromatic plates). He had mild visual field loss with an enlarged blind spot and an early arcuate scotoma in the left eye (Fig. 1a). Fundus examination revealed bilateral acute haemorrhagic papilloedema (Fig. 1b). A CT scan revealed a large destructive lesion centred on the occiput with soft tissue and bony fragments causing displacement of the dura and effacement of the venous sinuses whilst Fluid Attenuated Inversion Recovery (FLAIR) imaging showed white matter changes as well as temporal stem invasion (Fig. 1c). A magnetic reso- nance venogram later excluded venous sinus thrombosis and the patient was started on acetazolamide. Stealth guided excisional biopsy of the occipital lesion and bone marrow trephine confirmed the diagnosis of diffuse large B cell Non-hodgkin’s lymphoma (NHL). He was started on chemotherapy followed by bone marrow transplantation. Within 6 months there was complete resolution of his visual symptoms, papilloedema and visual field defect. Follow up of over 3 years with repeat bone marrow biopsies has failed to show any evidence of recurrence. Discussion First described by Critchley in 1951 [1] the term palinopsia, from the Greek words palin (again) and op- sis, (vision), is a rare posterior visual pathway disorder of persistent or recurrent visual images, following removal M. Ziaei (&) Á M. A. Elgohary Á F. D. Bremner Department of Eye, University College London Hospital, Third Floor, Central Wing, 250 Euston Road, London NW1 2PQ, United Kingdom e-mail: mahdi207@yahoo.com; m.ziaei@doctors.org.uk 123 Int Ophthalmol (2013) 33:553–556 DOI 10.1007/s10792-012-9682-6