Cerebral haemorrhage masking underlying primary glial tumour

Case contributed by Dr Andrew Lawson

Presentation

Sudden onset headache and right sided weakness. No history of hypertension.

Patient Data

Age: 64
Gender: Female

Large haemorhage in the posterior left temporal lobe with surrounding oedema. No intraventricular extension.

The MRI findings are consistent with a large, left temporal lobar haemorhage. No AVM was demonstrated on the MRA (not shown).

3 month follow up scan

Modality: MRI

A 6.2 x 5.0 x 3.6 cm irregularly peripherally enhancing mass in the left temporal lobe is associated with moderate surrounding oedema, with moderate mass effect. The sulci are effaced, with right-sided midline shift of 14 mm, and distortion of the left lateral ventricle. The left temporal horn is moderately prominent, appearing trapped. Some T1 hyperintensity is present together with patchy susceptibility in keeping with blood products. Heterogeneous diffusion restriction.

Conclusion: Solitary intra-axial tumour in the left temporal lobe has overall MRI findings most in keeping with a glioblastoma.

Case Discussion

This patient was not known to have hypertension or any history of a previous cerebral vascular event.

The haemorhage is not in a typical location to be classified as a 'hypertensive bleed', thus we label it as a "lobar bleed".

The patient has no other radiological evidence of microvascular disease. With the eye of faith there is possibly some faint enhancement along the left mesial temporal lobe, but it is hard to appreciate with so much high T1 signal secondary to the bleed.

Teaching point: have a high index of suspicion for a secondary cause of a bleed when the clinical context and anatomical location do not match.

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Case Information

rID: 26553
Case created: 27th Dec 2013
Last edited: 2nd Jun 2016
Inclusion in quiz mode: Included

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