Presentation
Headache
Patient Data
Multiple nodular T2/FLAIR hyperintensities in the subcortical white matter of left medial temporal lobe mildly extending to the medial occipital lobe. They abutting the overlying cortex, left hippocampus and possibly involve them. No evidence of calcification/hemorrhage, diffusion restriction or enhancement on the post-contrast studies are seen. No obvious gyral expansion or mass effect is seen.
Elsewhere, scattered, multiple focal T2/FLAIR hyperintensities are seen in subcortical white matter of bilateral frontoparietal lobes, likely non-specific white matter hyperintensities / migraine-related lesions.
Case Discussion
Appearances favor multinodular and vacuolating neuronal tumors in the left temporal lobe.
Dysembryoplastic neuroepithelial tumor (DNET) is a close differential. However, DNETs are 'bubbly' appearing lesions, primarily cortical based and cause expansion of the cortex which is not seen in this case.