Wk 6, Case 4 - Review

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Report

Patient History
Frontal mass

Findings
There is abnormal signal intensity in the left frontal lobe affecting the gyral pattern as well as the subcortical white matter seen across a wide area of the left frontal lobe including the paramedian anterior left frontal lobe and the lateral frontal lobe contents. There is thickening of the cortex with abnormal sulcal pattern. This area does not show contrast-enhancement. There is cortical thickening present. The overall extent of disease on the coronal scan measures approximately 5.4 cm in transverse dimension and 4.1 cm in superior-inferior dimension. Perfusion weighted examination shows no evidence of hypoperfusion. Delayed post gadolinium enhanced scans show no evidence of pathologic enhancement. There is no evidence of restricted diffusion.

There is no evidence of new enhancement. No areas of restricted diffusion are seen.

Impressions
Area of cortical thickening, abnormal sulcation, and subcortical white matter high signal intensity in the left frontal lobe. This is felt to represent a congenital developmental lesion such as cortical dysplasia or tuber as opposed to a neoplasm. Continued conservative follow-up is recommended.

Case Discussion

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Joshua P Nickerson, MD

Associate Professor of Neuroradiology

Oregon Health & Science University

Francis Deng, MD

Assistant Professor of Radiology and Radiological Science

Johns Hopkins University School of Medicine

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Wk 6, Case 4 - Review