Presentation
No history of neurological symptoms was admitted to the emergency department due to a convulsive status epilepticus.
Patient Data
Non-contrast-enhanced CT of the brain was performed immediately after the patient was admitted to the Emergency Department and showed vasogenic edema involving the right insular region, parietal and temporal lobes, with no hyperattenuating lesions.
Contrast-enhanced CT of the brain showed a single ring-enhancing 17 x 10 mm interaxial capsulo-lenticular lesion surrounded by vasogenic edema. Due to the abundant vasogenic edema and other imaging findings, the absence of focal neurological deficit or fever and the patient's history of prostate carcinoma, a malignant etiology was considered initially, suggesting either a metastatic lesion or a primary glial neoplasm.
Capsulolenticular 17 mm ring-enhancing lesion showed a high-intensity internal signal on both T1- and T2-weighted (not shown) images and a low-intensity signal peripheral halo in T1, T2 and SWI sequences. The lesion showed a central diffusion restriction. Vasogenic perifocal edema in the right capsular region, insula and temporal lobe were present, with no significative mass effect.
These findings were consistent with a subacute hemorrhagic lesion.
Case Discussion
Herein, we present a well-illustrated case of a subacute hematoma mimicking cerebral metastasis in the Emergency department.
There are many potential causes but classic examples of ring-enchancing cerebral lesions in the Emergency Department include abscesses, primary intracranial glial tumors, contusions and metastases. In this case, due to the absence of focal neurological deficits and no clinical or analytic symptoms suggesting infection, our first suspected diagnosis was malignant, either a primary glial neoplasm or a metastatic lesion because of the patient's history of prostate carcinoma.
However, an MRI was made showing a subacute hemorrhagic lesion.
This case highlights the importance of including subacute hematoma in the differential diagnosis of ring-enhancing intraaxial lesions. Moreover, it is important to consider that metastatic lesions usually appear in the corticosubcortical area, whereas basal ganglia and thalamus are more common locations for hypertensive hematomas.
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