Presentation
Apraxic gait.
Patient Data
Within the left parietal lobe there is a well-circumscribed lesion and a further smaller lesion abutting it anteriorly, both of which are hypointense on T1 with a thin rim of contrast enhancement, hyperintense on T2 and hypointense on flair. There is irregularity of the posterior rim of the larger lesion and focal nodularity at the posterolateral aspect of the rim of the smaller lesion. There is associated surrounding white matter T2/flair hyperintensity in keeping with vasogenic edema. The lesions demonstrate low signal on diffusion weighted imaging and high signal on ADC mapping, in keeping with T2 shine through. There is mild associated mass-effect with no midline shift, no subtentorial and no tonsillar herniation.
Conclusion: Two lesions likely to represent cerebral metastases.
A large left apical lung opacity abutting the aortic arch is highly suspicious for primary lung malignancy, probably with superimposed postobstructive collapse. Remainder of the lungs are clear. Normal heart size. No pleural effusion.
Case Discussion
The patient went on to have a biopsy which confirmed the presence of a primary lung carcinoma with cerebral metastases.
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