Presentation
New onset confusion.
Patient Data
There are two ring-enhancing lesions with surrounding vasogenic edema. One in the right parietal lobe measuring and one centered on the left basal ganglia measuring. There is partial effacement of the left lateral ventricle and the right ventricular trigone, however, there is no midline shift nor cerebral parenchymal herniations.
The patient had a known history of lung cancer, and these two lesions are compatible with cerebral metastases.
48 hours after the first CT, the patient was noted to have sudden onset of left upper and lower limb weakness.
New large left basal ganglia hemorrhage, centered laterally to the previously described mass with a thin rim of edema. New rightward midline shift of 4 mm. No further acute intracranial hemorrhage. Right parietal mass and edema are stable.
Case Discussion
This patient had a known history of metastatic lung cancer, and these intracranial masses are almost certainly cerebral metastases, of which intracranial hemorrhage is a common complication.
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