A headache, mental disorders, slowly progressing cognitive deficiency
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An ill-defined area of abnormal signal intensity in the left temporal lobe with the involvement of the amygdala, the temporal pole, in part of the upper temporal gyrus and the insula. There is a small mass effect (sulcal effacement). The area demonstrates no contrast enhancement and doesn't restrict diffusion; on the contrary, the ADC value was quite high.
In SVS (PRESS TE=288 ms) there is high choline (Cho) peak, which is three times more than N-acetylaspartate (NAA) peak. There is also a definite lactate peak (Lac/lip). The main ratios: Cho/Cr = 2.05, Cho/NAA = 3.34.
In this case, the clinical presentation was relatively non-specific and ambiguous. The main differentials include diffuse astrocytoma, herpes simplex encephalitis, and middle cerebral artery infarct. A pattern of the lesion was very similar to HSV-encephalitis, but high ADC values and mass effect (sulcal effacement) make us suspect a tumor. Thurthermour the finding of very high choline peak and elevation of the ratio Cho/Cr and Cho/NAA make the diagnosis of the diffuse astrocytoma more likely. The presence of the lactate peak could indicate a higher grade.