• 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”


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


    • 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?
    • Stereotactic bx v. resection depends on imaging findings of possible primary.
    • Good case
    • This case corresponds to Neurocysticercosis
    • Genetic Studies recommended with FHx.

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site here. Privacy Policy