Presentation
Right sided paresthesia and motor dysphasia for 1 hour - TIA?
Patient Data
No evidence of intracranial hemorrhage or infarct.
Enhancing lesion measuring 9 x 11 x 11 mm centered on the left external capsule, with profuse perifocal edema. Most probably a metastasis.
Normal ventricles, cisterns and sulci.
In the left insula, there is a small ~10 mm enhancing lesion with significant edema. The edema involves frontal and temporal gray matter and seems more than peritumoral edema - this is possibly an infiltrative tumor with a focus of internal enhancement, not necessarily a metastasis with peripheral edema.
No evidence of infarct or hemorrhage. Craniocervical junction normal. On DWI, no evidence of acute infarct. On SWI, no evidence of hemorrhage.
In summary: left frontotemporal lesion whose characteristics favor a primary malignancy - GBM?
Case Discussion
Right-sided paresthesia and motor dysphasia lasting ~1 hour. During the short stay at the hospital, had an episode of uncontrollable lip movements. MRI brain showed an infiltrative malignancy centered on the left insula. Was started on valproate and dexamethasone with improvement on the following day. After several days, a stereotactic biopsy was obtained. Received presurgical ALA-5, then the lesion was treated with fluorescence under UV light.
Pathology: High-grade glioma IDH-mutant; malignant transformation from low-grade glioma.
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