Cerebral metastases - from lung cancer

Case contributed by Dr Nikola Todorovic

Presentation

In-patient on chemotherapy for lung cancer, sent by their neurologist for a brain MRI because of worsening of the patient's condition with headaches, vomiting, acute left eye blindness, inability to close the left eye and left facial nerve paresis.

Patient Data

Age: 65 years
Gender: Female

Frontally, parasagittally on the right, there is a focal expansive lesion hyperintense on T2 and FLAIR, hypo to isointense on T1 with a strong postcontrast signal intensity enhancement, without a perifocal oedema.
In the left cerebellar hemisphere, there is another focal expansive lesion with intensive postcontrast signal intensity enhancement.
Finally, there is an expansive lesion in the left middle cerebellar peduncle and adjacent cerebellar parenchyma hyperintense in T2 and FLAIR, hypo to isointense on T1, with intense postcontrast signal intensity enhancement, with perifocal oedema in the pons and medulla oblongata.
All tree lesions are most probably metastases.
Besides this, there is a dilatation of the lateral ventricles, a periventricular hyperintensity (T2 and FLAIR) consistent with the leukoencephalopathy and multiple lacunar and punctiform old ischemic lesions, consistent with a microangiopathy.

Case Discussion

The patient was on chemotherapy for the squamous cell carcinoma of the lung, and after the second cycle, acute state worsening with already listed symptoms occurred.

After the examination by a neurologist, the patient was sent for a  CT (not shown), which showed no metastatic lesions. Due to continuous worsening of her condition, brain MRI was performed which showed already described lesions, which in this clinical setting almost certainly represent metastases.

This fact puts this patient into stage IV according to the lung cancer staging system, with very poor prognosis.

 

 

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Case information

rID: 52901
Case created: 25th Apr 2017
Last edited: 26th Apr 2017
Inclusion in quiz mode: Excluded

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