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24b - Answer: 59-year-old female presents with blurred vision

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 59-year-old female presents with blurred vision, and headaches for six months.

(QUIZ ANSWER) NOT A LIKELY DIFFERENTIAL: 

Benign meningioma.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS:

10 x 3.2 x 6.5cm left calvarial, extracalvarial and intracranial extraaxial mass with mass effect upon the left frontal lobe which extends near to the midline without underlying acute edema. 

There is effacement of the left lateral ventricle. 

Hyperintensity on T2 within the left temporal horn may represent a neuroepithelial cyst. 

There is temporal horn enlargement on the right which may represent early hydrocephalus. 

The adenoids are prominent. 

Craniocervical junction is without Chiari malformation. 

Subcortical hyperintensities may represent gliosis of microangiopathic origin. The lesion appears to be extraaxial. There is mild shift of the midline of approximately 5mm. 

Seventh and eighth nerve complexes are intact. Cochleae and vestibula are intact. Otomastoid airspaces are clear. 

The sagittal sinus signal is attenuated, but flow may be preserved. 

CONCLUSION: 

1. Large left extraaxial mass with subdural calvarial and extracalvarial components and mass effect upon the left frontal lobe without acute edema or hemorrhage. 5mm of midline shift and left ventricular effacement. Differential may include lymphoma, malignant meningioma, hemangiopericytoma, melanoma. 

2. Prominent adenoids may be supportive of lymphoproliferative etiology. 

3. Temporal horn dilatation on the right may be suggestive of early hydrocephalus.

LESSON 3, TOPIC 42

Case Challenge: Brain MRI Cases

Case Challenge

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Content reviewed: July 23, 2021

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