Case Challenge

Brain

Neuro

Stephen J Pomeranz

Gain confidence diagnosing Brain Tumors w/ MRI with practice cases from MRI Online. Quiz yourself using real-world, interactive scrollable cases & earn CME!

Case Review

Neuroradiology

Post-Course Activities

This Power Pack is comprised of 10 unique Brain Tumor MRI cases that you can scroll through in our diagnostic web viewer to determine your findings. Quiz yourself and earn CME.

Brain Tumors MRI Cases

Case 3 - 80-year-old female presents with history of left leg numbness

<div>HISTORY:&#160;This 80-year-old female presents with history of left leg numbness.(QUIZ ANSWER) FAVORED DIAGNOSIS IN THIS CASE:&#160;Hematoma.Using the&#160;diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.FINDINGS:A 22 x 29 x 22 mm heterogeneous lesion with peripheral edematous change in the posterior aspect of the right basal ganglia and mild mass effect to the right thalamus and adjacent temporal lobe represents a hematoma, germ cell tumor or a glial tumor. Further evaluation with IV contrast and CT scan without contrast is suggested. There are multiple periventricular and deep white matter changes, less conspicuous in parietal subcortical region, suggestive of microangiopathic gliosis. No other masses or abnormal densities are seen. Mild midline shift is demonstrated due to the right basal ganglia lesion. However, no sulcal effacement is seen. No extraaxial fluid collection or hemorrhage is demonstrated. The posterior fossa is unremarkable. The visualized vessels are normally seen. The sella is normally seen. Hydrocephalus is seen.&#160;The visualized paranasal sinuses are well aerated. The mastoid bones are also well aerated. The optic globes are intact. No intraconal space lesions. The visualized neck soft tissues are unremarkable.&#160;CONCLUSION:&#160;1. A 22 x 29 x 22mm (transverse x AP x height) right basal ganglia hematoma is favored over a germ cell tumor or glial cell tumor. Request two week followup to evaluate for resolution and shrinkage. Further evaluation with Gradient images, IV contrast images, MR spectrography might be included. Based on age, hypertensive hemorrhage or hemorrhage related to anticoagulation and least likely amyloidosis are considerations.2. Extensive vasculopathic gliosis consistent with hypertension or arteriosclerosis.&#160;Gliosis of the brainstem consistent with VBI or vertebrobasilar insufficiency.</div>

Case

In this case, there is a 22 x 29 x 22 mm heterogeneous lesion with peripheral edematous change in the posterior aspect of the right basal ganglia. Regarding this, which of the following is the favored diagnosis?