Presentation
Progressively worsening expressive and receptive aphasia.
Patient Data
There is an ill-defined hyperintense T2/FLAIR signal mass within the left corona radiata and thalamus, with inferior extension of signal abnormality into the left optic radiation and left temporal stem. There is gyriform/subcortical hyperintense T2/FLAIR signal within the left medial and anterior temporal lobe. There is evidence of local mass effect with effacement of the posterior body of the left lateral ventricle and third ventricle.
On MR spectroscopy, there is diminution in the NAA peak, decreased NAA/creatine and NAA/choline ratios, and modest absolute elevations of choline and creatine peaks. There is no significant lipid-lactate elevation.
Case Discussion
This is a pathologically confirmed thalamic glioblastoma. The patient is status post radiation therapy and 10 cycles of temozolomide.
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