We describe a patient with primary CNS lymphomas, awake despite an extreme ICP elevation. A 48-year-old woman presented with headache since 1 month, and bilateral papillary edema was observed. Magnetic resonance imaging revealed diffuse infiltration around the petrous bone. Following external ventricular drainage (EVD) placement, ICP levels of > 90 mmHg were recorded while the patient was fully awake. Cytology revealed an aggressive primary CNS lymphoma. Cerebrospinal fluid (CSF) drainage at high opening pressure levels was required. We conclude that extreme ICP elevations, treatable by CSF drainage, can be observed without a reduced level of consciousness.

我们描述了一名原发性中枢神经系统淋巴瘤患者，尽管ICP极度升高，但仍处于清醒状态。一名48岁妇女自1个月以来出现头痛，并观察到双侧乳头水肿。磁共振成像显示在骨周围弥漫性浸润。放置外部心室引流（EVD）后，患者完全清醒时记录的ICP水平> 90 mmHg。细胞学检查发现侵袭性原发性中枢神经系统淋巴瘤。需要在高开启压力水平下进行脑脊液（CSF）引流。我们得出的结论是，可以观察到极端的ICP升高，可以通过CSF引流治疗，而不会降低意识水平。