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).
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.
Published online: August 24, 2015
© 2015 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
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- Headache, dysphasia and a left temporal lobe mass: answerJournal of Clinical NeuroscienceVol. 24