Fig. 14. Response of a lymphoid tumor to intracarotid chemotherapy. A 62-yr-old right-handed woman presented with three symptomatic white chorioretinal lesions in the right eye. A vitreal biopsy showed small lymphoid cells. Six months later, the patient started experiencing problems while walking. Magnetic resonance imaging revealed contrast-enhancing lesion in the brain (  A –  D ). A stereotactic brain biopsy showed large B-cell lymphoma, CD20 positive. Cerebrospinal fluid contained 20 atypical cells/ml. The patient underwent first treatment with blood–brain barrier disruption with intracarotid mannitol and intraarterial methotrexate, and carboplatin that was supplemented with intravenous rituximab. She was admitted every 4 weeks for 2 consecutive days of the same treatment with barrier opening and intraarterial chemotherapy in one of the major brain-feeding arteries, the left or the right internal carotid or the vertebral artery. She was also treated with intraocular rituximab and methotrexate. After eight courses of treatment, there was radiologic evidence of complete tumor regression (  E –  H ) without any neurologic symptoms or evidence of intraocular disease. Images and case history are courtesy of Edward A. Neuwelt, M.D. (Professor of Neurology and Neurosurgery, Oregon Health and Science University, Portland, Oregon).