The Patient with Visual Disturbances and Right-Arm Shaking

A 57-year-old woman first presented with a severe headache and tonic-clonic seizures, with CT imaging showing hyperdensities of the left parietal lobe that were suspicious for subarachnoid hemorrhage. Follow-up imaging was consistent with an arteriovenous fistula, which was embolized. However, in the next 6 months, she experienced worsening seizures and cranial neuropathies. Brain MRI revealed intrinsic T1 hyperintensities (see Figure 1), and cerebrospinal fluid studies were unremarkable. A meningeal biopsy confirmed a primary melanocytic tumor.