Severe headache for about 2-3 months' duration, sometimes awakening the patient from sleep.
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A large partially well-defined oval-shaped lesion is seen in the left frontotemporoparietal region. The lesion measures 70 x 45 x 70 mm in maximal AP, transverse and craniocaudal diameters, respectively. It shows an iso- to a hypointense signal on T1WI with a heterogeneous component (necrosis) and heterogeneously hyperintense on T2W and FLAIR images, with reduced DWI signal and increased ADC values on DWI/ADC map sequences (free diffusion) with thick irregular peripheral and nodular areas (heterogeneous) of enhancement on post-contrast T1WI.
The lesion is surrounded by grade II perifocal brain edema showing low signal in T1WI and high signal on T2WI.
The lesion and edema exert a mass effect in the form of effacement of the cortical sulci, compression of the ipsilateral ventricle and contralateral shift of the midline structures.
The above findings are in favor of a high-grade tumor/glioblastoma (GBM).
Normal posterior fossa.
Total obliteration of both maxillary sinuses showing low T1 signal and high T2 signal, denoting sinusitis.
The other paranasal sinuses are clear.
Unfortunately, the patient has been passed away before histopathological confirmation is done.
Note: This case didn't have histological confirmation and thus IDH status is not available. As such, this tumor would now be classified as a probable glioblastoma NOS.