Concluded Case

Tumifactive demyelination vs Balo concentric sclerosis

New case 51 yr ,F ,DM,Hypertensive ,presented with progressive heaviness and stiffness with weakness of left lower limb since 6 weeks. NO DEFINITE WEAKNESS OF LEFT UPPER LIMB. No headache / seizures/ urinary problem. ON Exam: Bp140/ 80 mmhg ,on med . Optic fundi normal . Left lower limb gr 3 + / 5 with mild spasticity left upper limb gr5/ 5 with normal tone. Left knee and ankles hyperactive 3+ with left extensor plantar. Lt upper limb mild asymmetry in the DTRs compairing rt side.With support she is able to walk.MRI done ,referred the case to Neurosurgeon. What abnormality in the MRI & What is the possible diagnosis?.

LikeAnswersShare
Concluded answer
Thanks for all answers. Discussion What abnormalityinthe MRI? What is the possible diagnosis? Surgery not done. Received a course of IV Methyl prednesolone,discharged,clinically better but on close follow up. Ref to Neurosurgeon for biopsy,but patient and relatives wanted to wait . CSF normal including IgG, oligoclonal band. MRI : A well defind mass,in the Rt frontal region,paramedian subcortical and deep white matter with central T2 hyperintensity and peripheral concentric hypo and hyperintense signals,peripheral diffusion restriction,with differentially enhancing outer and inner rim and central necrotic areas with no elevated perfusion.Significant perilesional edema noted. To consider Fumifactive demyelination vs Balo concentric sclerosis.
All Answers
It's a SOL, in rt frontoparietal region . Over motor cortex. Enhancing with central non enhancing part. With surrounding edema. MRS also shows raised creatinin &choline peak. It's a tumor. Possibility of metastasis. Get metastatic work up done. Surgical excision should be planned.
I agree
1
Thanks for all answers. Discussion What abnormalityinthe MRI? What is the possible diagnosis? Surgery not done. Received a course of IV Methyl prednesolone,discharged,clinically better but on close follow up. Ref to Neurosurgeon for biopsy,but patient and relatives wanted to wait . CSF normal including IgG, oligoclonal band. MRI : A well defind mass,in the Rt frontal region,paramedian subcortical and deep white matter with central T2 hyperintensity and peripheral concentric hypo and hyperintense signals,peripheral diffusion restriction,with differentially enhancing outer and inner rim and central necrotic areas with no elevated perfusion.Significant perilesional edema noted. To consider Fumifactive demyelination vs Balo concentric sclerosis.
D/d high grade glioma vs abscess Rt parasalital SOL with perilesional edema t1 hypo to iso T2 hyperintesity with central hypointensity with contrast enhancement double ring sign (target sign) Mrs s/o choline peak favouring high grade glioma
I agree
0
What should we call it, blooming Glioma?!
Right Para sagittal meningioma
Thank you doctor
0
Atrophic changes
Thank you doctor
0