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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).
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.
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