Presentation
A middle-aged woman with a previous diagnosis (poorly established) of MS, now presents with left-sided hemiparesis.
Patient Data
MRI of the brain demonstrates extensive poorly defined areas of white matter hyperintensity with a distribution consistent with demyelination.
In the posterior right frontal lobe and parietal lobe a mass with surrounding vasogenic-type edema is present which demonstrates solid if somewhat heterogeneous contrast enhancement. Further contrast enhancement is seen tracking along the occipital and temporal horn of the lateral ventricle.
Imaging of the spinal cord confirms typical appearances of demyelination.
Case Discussion
This finding above all others strongly suggests that this lesion represents a tumor (most likely a glioma) rather than tumefactive demyelination. This was confirmed on histology which demonstrated a glioblastoma.
Note: IDH mutation status is not provided in this case and according to the current (2016) WHO classification of CNS tumors, this tumor would, therefore, be designated as a glioblastoma NOS.
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