• HPI: A 31-year old woman presents for admission to a psychiatric hospital for acute bipolar exacerbation and psychotic episode. Imaging during her work-up demonstrates an intraventricular lesion and she, therefore, undergoes an MRI during that admission (Figure 1). She denies any headache complaints and ROS is essentially negative. 

    1. Bipolar disorder. 
    2. Intermittent psychotic episodes. 

    1. Risperdal. 
    2. Cogentin. 
    3. Abilify. 
    4. Claritin. 

    Social Hx: Pt is divorced and has no children. She is a PhD student at the local university but is currently on medical leave. Denies any tobacco, alcohol or
    illicit drug use. 

    Family Hx: Unremarkable. 

    Physical exam: Vital signs are normal. Memory is intact. Speech is fluent. Affect is flat. Cranial nerves are intact. Strength and sensation are full. Reflexes, gait, and cerebellar function are normal. 

    Figure 1. Axial T1 post-contrast MRI

    Figure 2. Axial T2 MRI

    Figure 3. Axial diffusion weighted MRI

    Figure 4. Coronal T1 post-contrast MRI

    Figure 5. Sagittal T1 pre-contrast MRI

    1. What is the most likely diagnosis?

    2. What is your next step in management?

    3. What is your surgical approach?

    4. You decide to take her to the OR for an endoscopic biopsy and resection. Where would you place your entry point/burr hole? Over the:

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

    The patient is taken to the OR for endoscopic biopsy and planned resection. Intraoperative biopsy demonstrates central neurocytoma. She undergoes complete resection without complication and she is discharged from the hospital after 4 days.

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