Presentation
Sudden collapse.
Patient Data
There is a well defined solid mass within the region of the cerebellar vermis that is characterized by a thick hyperdense rim and a central hypodense component. Associated vasogenic edema and mass effect noted over the fourth ventricle. No hydrocephalus. No other brain lesions identified.
MRI confirms a ring-enhancing intra-axial cerebellar mass surrounded by vasogenic edema and local mass effect. No diffusion restriction to suggest an abscess. Metastatic disease is favored over a primary CNS lesion.
Case Discussion
This case brings a differential diagnosis approach commonly seen on radiology exams, where you should work-up relevant descriptors to entertain the possible causes:
- location
- intra vs extra-axial
- supra vs infratentorial
- single vs multiple
- patten: ring-enhancing lesion
- thick and nodular vs thin and smooth
- complete vs incomplete
- age group:
- children vs young adult vs aduld/elderly
Please, refer to the article on cerebral ring enhancing lesions for further discussion on differentials.
This case was confirmed to represent breast cancer metastasis. The patient had a known history of previous mastectomy due to invasive ductal carcinoma.