en Brain Tumors Case report <div style="text-align: justify;"><span style="font-size:11pt"><span style="line-height:29.333336px"><span style="font-family:Calibri, sans-serif"><span style="color:#000000"><span style="font-style:normal"><span style="font-weight:400"><span style="white-space:normal"><span style="text-decoration:none"><b><span style="font-size:12pt"><span style="line-height:32px"><span new="" roman="" style="font-family:" times="">Background and importance: </span></span></span></b><span style="font-size:12pt"><span style="line-height:32px">Chronic lymphocytic leukemia (CLL) is the most common lymphoproliferative disorder in the United States. CLL invasion to the central nervous system (CNS) is a scarce complication followed by diverse outcomes. Moreover, symptomatic CNS lesion as the primary clinical presentation of undiagnosed CLL is extremely rare. In CNS involvements, it usually invades leptomeningeal, and less commonly causes parenchymal lesions.</span></span></span></span></span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:29.333336px"><span style="font-family:Calibri, sans-serif"><span style="color:#000000"><span style="font-style:normal"><span style="font-weight:400"><span style="white-space:normal"><span style="text-decoration:none"><b><span lang="EN-GB" style="font-size:12pt"><span style="line-height:32px">Case Presentation:</span></span></b><span style="font-size:12pt"><span style="line-height:32px"> We introduce 71 years 71-year-old man with a history of CLL referred to our center with headache and lower extremities weakness CNS involvement. After the initial evaluation, the MRI findings revealed a &ldquo;ring or target sign&rdquo; both in the temporal lobe and intramedullary spinal cord according to T9-T10. Surgical resection of the temporal lesion was done and CLL was confirmed with histological findings. </span></span></span></span></span></span></span></span></span></span><br> <span style="font-size:11pt"><span style="line-height:29.333336px"><span style="font-family:Calibri, sans-serif"><span style="color:#000000"><span style="font-style:normal"><span style="font-weight:400"><span style="white-space:normal"><span style="text-decoration:none"><b><span style="font-size:12pt"><span style="line-height:32px">Conclusion</span></span></b><span style="font-size:12pt"><span style="line-height:32px">: Finally, the primary presentation of CLL with CNS involvement is an uncommon occurrence. It doesn&#39;t show a preference for age, gender, or ethnicity and can occur at any stage of CLL. Therefore, it is important to be aware of this possibility when patients with a history of CLL present with neurological symptoms</span></span></span></span></span></span></span></span></span></span><br> &nbsp;</div> Chronic lymphocytic leukemia, Metastasis, Central Nervous System 221 227 http://irjns.org/browse.php?a_code=A-10-317-5&slc_lang=en&sid=1 Emad Saiedi Saeedieemad68@gmail.com 100319475328460011361 100319475328460011361 No Department of Neurosurgery, Mashhad University of Medical Sciences, Iran Shahab Mahmoud-Nejad shmahmoudnejadf@gmail.com 100319475328460011362 100319475328460011362 No Department of Neurosurgery, Mashhad University of Medical Sciences, Iran Saman Mohazzab-Torabi smntrb@gmail.com 100319475328460011363 100319475328460011363 Yes Department of Neurosurgery, Mashhad University of Medical Sciences, Iran Babak Ganjeifar b.ganjeifar@gmail.com 100319475328460011364 100319475328460011364 No Department of Neurosurgery, Mashhad University of Medical Sciences, Iran