A 58-year-old man with multiple myeloma presented with a 3-month history of a sensation of occipital pressure, transient blurring of vision and increased bone pain. Funduscopic examination revealed disc swelling, tortuous veins and superficial retinal hemorrhages simulating early hyperviscosity syndrome. Clinical investigation and computerized tomography, however, indicated that an intracranial plasmacytoma was the cause of his papilledema. Cobalt 60 beam therapy and vincristine were added to his treatment regimen. Seven weeks later the intracranial tumour had almost totally disappeared. Symptomatic cerebral compression from an intracranial plasmacytoma associated with systemic disease is uncommon. The diagnosis and management are reviewed.