Cerebral metastasis causing confusion (student teaching)

Case contributed by UoE Radiology


Altered mental state with rapid onset confusion. Unable to follow simple commands. No medical history of note.

Patient Data

Age: 70
Gender: Male

Performed to exclude stroke

No evidence of ischaemic or haemorrhagic stroke. No extra-axial bleeds or collections.

Ring shaped lesion in left occipital lobe with hypodense centre and surrounding hypodensity.


Head with contrast

Avidly enhancing ring lesion in the left occipital lobe.

Compression of occipital horn of lateral ventricle.

Surrounding vasogenic oedema.

MRI was performed and could not differentiate between a primary brain tumour or a metastasis (with no known primary lesion).

The patient had further tests (including tumour markers) and scans.


chest/abdomen/pelvis imaging

Thickened bowel mucosa with narrowed lumen around caecum/ascending colon. 

No pneumoperitoneum.

No chest, hepatic or bony lesions. Simple renal cysts (off these images).

Case Discussion

This elderly gentleman was admitted with rapid onset confusion.

Head imaging revealed a ring shaped lesion which was characterised on CT, contrast CT and MRI.

Further tests revealed an elevated CEA, and caecal adenocarcinoma was found on body CT.

The patient had the brain metastasis removed as it was a solitary metastasis from the GI malignancy.


Thanks to Dr Hani Salam for contributing this impressive case. The case with additional imaging can be found here.

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Case information

rID: 37577
Case created: 14th Jun 2015
Last edited: 29th Oct 2017
Inclusion in quiz mode: Included

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