Cerebral infarction mimicking tumour

Case contributed by Dr Andrew Lawson

Presentation

Young man with headache and left sided weakness.

Patient Data

Age: 33
Gender: Male

Wedged shaped region of low density change in the right temporal lobe.

The CT hypodense lesion in the right temporal lobe corresponds to a 5.5 x 3.2 cm FLAIR hyperintense mass lesion that involves both grey matter and white matter, with cortical thickening most notably involving the inferior bank of the superior temporal and superior bank of the middle temporal gyri. Areas of internal curvilinear enhancement are identified, some of which are likely meningeal/sulcal. Associated diffusion restriction. No other intra-axial lesion is identified apart from a punctate focus of FLAIR hyperintensity in the left frontal subcortical white matter.

Conclusion: Findings are indeterminate and may represent a glioma with high grade features. A subacute infarct could have similar appearances. Followup imaging will clarify. 

MRI

MRI brain - 6 weeks later

6 week follow up scan

There has been a decrease in the extent of FLAIR signal abnormality within and around the superior and middle temporal gyri of the right temporal lobe. No progressive mass-effect is demonstrated. Increased T1 gyral cortical signal and minor enhancement is seen compatible with laminar necrosis. No haemosiderin staining on the susceptibility weighted images. The DWI has normalised.

Conclusion: Findings compatible with evolution of a right temporal infarct. Laminar necrosis is now evident.

Case Discussion

This case beautifully demonstrates how similar a primary brain neoplasm and subacute infarction can be on imaging. Follow up can make things clearer before getting surgical knives involved!

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Case information

rID: 26543
Case created: 27th Dec 2013
Last edited: 18th Jan 2016
Inclusion in quiz mode: Included

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