Presentation
Brought in by family secondary to increasing confusion and functional decline over the past week.
Patient Data
Multifocal, bilateral, hyperdense parenchymal masses (right frontal, left frontal operculum, left middle frontal gyrus, pons) with surrounding vasogenic edema. There are periventricular and subcortical white matter hypodensities consistent with microvascular type changes. Incidental left middle cranial fossa arachnoid cyst. Extensive bilateral scalp soft tissue masses, some of which demonstrate central necrosis and ulceration. Atherosclerotic calcifications of the intracranial vasculature. A metastatic deposit is illustrated in the left parotid gland.
Case Discussion
80-year-old male with a history of atrial fibrillation, diabetes mellitus type 2, hypertension, anxiety, and active malignant melanoma. The patient was diagnosed with scalp melanoma 2 years ago via biopsy but treatment was not pursued. Patient was ultimately transitioned to hospice support and care.
Case authors: Saud Rehman M.D., Rafeh Waheed D.O. and Doug Harnett-Robinson M.D.
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