Images in Neuroscience: Question| Volume 24, P122, February 2016

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Headache, dysphasia and a left temporal lobe mass: question

Published:August 24, 2015DOI:

      1. Case description

      A 55-year-old Asian man, with no prior medical history, was referred to our tertiary neurosurgery department with a 3 month history of worsening headaches, dizziness and intermittent difficulties with word finding. An initial non-contrast brain CT scan was performed at the onset of symptoms, but demonstrated no abnormalities. A contrast-enhanced CT scan, performed 2 months following symptom onset, showed an enhancing lesion in the anterior left temporal lobe with significant vasogenic oedema. After an initial review by a neurologist, he was referred for a neurosurgical consult for consideration of a surgical resection.
      On examination, the patient was afebrile. There were no focal neurological signs, including no evidence of dysphasia. A routine blood examination, including white cell count and C-reactive protein, was normal.
      A gadolinium-enhanced MRI was performed, and revealed an enhancing 2.3 × 1.4 cm anterior left temporal lobe lesion with low T1- and high T2-weighted signal intensity that was associated with significant vasogenic oedema throughout the left temporal lobe. The lesion demonstrated restricted diffusion on diffusion weighted sequences (Fig. 1).
      Figure thumbnail gr1
      Fig. 1(A) Axial T1-weighted MRI post-gadolinium of the brain showing a high signal intensity lobulated lesion in the anterior left temporal lobe. (B) Axial T2-weighted sequence again showing high signal intensity in the lesion, associated with vasogenic oedema.

      2. The most likely diagnosis is:

      • A.
        Tumour (high grade glioma)
      • B.
        Tumour (metastasis)
      • C.
        Venous infarct/haemorrhage
      • D.
        Intracerebral abscess
      • E.
        Hypertensive haemorrhage
      Answer on page 169

      Conflicts of Interest/Disclosures

      The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.

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