MRI obtained a few days later after referral to our institution.
Centred within the lateral aspect of the right temporal lobe (middle temporal gyrus) with a cortical/sub cortical origin is an intra axial multi lobulated predominantly solid mass with cystic components. The solid mass is hypo to iso intense on T1 and slightly hyper intense on T2 imaging. The cystic component is hypointense on T1 and hyperintense on T2. The approximate measurement of the mass in orthogonal planes is 2.8 x 1.9 x 2.9 cm. Mild diffusion restriction suggesting increased cellularity of the solid component. There is T2/FLAIR signal abnormality in keeping with vasogenic oedema extending from the right temporal lobe into the anterior parietal lobe, into the posterior aspect of the sub insular region and the lateral aspect of the posterior limb of the internal capsule. On post-contrast imaging the solid component of the lesion enhances vividly with non-enhancement of the cystic component. No evidence of blood products within the lesion.
The mass causes expansion of the lateral aspect of the temporal lobe, with effacement of sulci and enlargement of gyral folds. There is a local mass effect but no midline shift or uncal herniation. No hydrocephalus. There is the suggestion of subtle bony remodelling and thinning of the adjacent skull.
MRS with the voxel placed over the solid enhancing component of the lesion demonstrates increase in Choline and mildly reduced NAA (not shown). There is increased CBV within the solid enhancing component.