A 67-year-old male presented with headache, facial weakness, and limb weakness. Imaging showed lesions in the left thalamus, midbrain, pons, and cerebellum enhancing on MRI. Biopsy of the thalamic lesion found diffuse large B-cell lymphoma. Further testing found lymphoma in peri-renal soft tissue as well. This represents either secondary CNS lymphoma with systemic involvement or synchronous primary lesions, unusual for primary CNS lymphoma.