• HPI

    • 74 year old man who presents with sudden onset of right homonymous hemianopia and right face parasthesias
    • PMH: arthritis, no previous h/o cancer
    • Soc HX: former smoker: 2 PPD x 14 years, quit in 1970
    • Family HX: father died of GBM, mother had “benign brain tumor”

    Exam

    • Neurologically intact except for dense right homonymous hemianopia and decreased right face sensation to light touch

    Labs

    • WBC 8.9 (Neutrophil 70.9; Lymph 19.7; Monos 5.8; Eos 0.9; Basos 0.2)
    • ESR 11
    • CRP 2.2
    • HIV test: pending

    Figure 1. Pre-gadolinium TI MRI

    Figure 2. Post-gadolinium T1 MRI

    Figure 3. DWI

    Figure 4. ADC

    1. Workup should include:

    2. The DWI findings suggest

    3. I would treat this patient initially with:

     

    4. Which of the following statements regarding pathology that may present as a ring enhancing lesion is false?

    5. Which of the following describes you?

    6. I practice in one of the following locations.

    7. Please add any suggestions or comments regarding this case:

    • I practice in Puerto Rico
    • very cool
    • in Asia (Indonesia), the differential diagnosis should include Cerebral Tuberculoma
    • It can be metastatic brain tumour
    • The results of the CT of chest/abd and pelvis may alter my choice of treament options. If there is a lesion to biopsy elsewhere, then a diagnosis can be made without crani or stereotactic brain biopsy, and then SRS may be a decent option.
    • Could be a tuberculoma but probably metastasis is a more likely diagnosis would definitively do a steriotactic biopsy.What about MR spectroscopy?
    • LIKELY ABCESS OR METSTASIS
    • Stereotactic bx v. resection depends on imaging findings of possible primary.
    • Good case
    • This case corresponds to Neurocysticercosis
    • Genetic Studies recommended with FHx.

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