- 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?
- 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.