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Cerebral metastasis causing confusion

Case contributed by UoE Radiology
Diagnosis certain

Presentation

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

Patient Data

Age: 70 years
Gender: Male

Performed to exclude stroke

ct

No evidence of ischemic or hemorrhagic stroke. No extra-axial bleeds or collections.

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

Head with contrast

ct

Avidly enhancing ring lesion in the left occipital lobe.

Compression of occipital horn of lateral ventricle.

Surrounding vasogenic edema.

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

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

Thickened bowel mucosa with narrowed lumen around cecum/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 characterized on CT, contrast CT and MRI.

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

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

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

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