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A 43-year-old man was diagnosed with Burkitt’s lymphoma. He had no evidence of central nervous system (CNS) involvement. He was treated with a CODOX-M/IVAC regimen with excellent response. In the last cycle, he complained of nausea and hiccups the day after intrathecal treatment. Cerebral magnetic resonance imaging (MRI) revealed leptomeningeal involvement (Figure 1a). There was no evidence of lymphomatous infiltration in the cerebrospinal fluid sample cytologically, flow cytometrically, or biochemically. His symptoms resolved within 3 days and he was accepted as having a leptomeningeal reaction associated with intrathecal treatment. There was no evidence of meningeal involvement upon cerebral MRI after 2 months (Figure 1b).

Cerebral MRI Mimicking Pachymeningeal Involvement Associated with Intrathecal Treatment