Concluded Case

Rt sided parafalcine Meningioma

44yr ,M ,working aboard,Six episodes of left leg focal clonic movements followed by loss of conciousness with stiffness of the body and clonic movements with out any post ictal symptoms ,and with out any known comorbidities Chief Complaints Six months ago ,while sitting doing office work he felt clonic movements of the left leg.With in seconds he became unconcious and his colleagues noted loss of conciousnes with stiffness of the body and clonic movements of both upper and lower limbs with out any frothing,urinary incontinence or focal weakness. Evaluated at nearby hospital, receivedI IV fluids.On the way to hospital he became concious .A month later he had two episodes in the same day exactly similar to the previous one.Evaluated at the same hospital, started on Depakine.3rd episode a month ago in the flight on the way to India.A week ago he missed one dose of Depakine and had two episodes ,1st one only vlonic movements ,2nd was major one. Following the 2nd episode, he noted left foot weakness lasted for 10 mts. History No significant past medical illness.No family history of seizure.Non smoker.Occ ethanol, once a month . Vitals Afebrile,Bp140/ 80 mmhg,HR 70/ mt. Physical Examination Intact higher functions,speech, optic fundi and cranial nerves.Motor system gr5/ 5 ,except dorsiflexion and ankle flexion of Lt foot gr 4/ 5. DTRS left knee and ankle jerks hyperactive with flexor pkantars. Intact sensations. Investigations EEg Rt frontal slowing. MrI rt supratentorial SOL( details for discussion) Diagnosis Rt supratentorial Mass lesion( details for duscussion) Management Ref the case to Neurosurgeon for further Management.

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Concluded answer

Thanks Curofy and others. MRI brain shows * well defind large parafalcine heterogeneously enhancing extra axial lesion with few centeal and peripheral non enhancing area showing no diffusion restriction in DWI ,in the Rt frontal region ,minimal hemorrhagic changes within . * The lesion invaginate in to the Rt frontal lobe displacing the medial half of the Rt frontal lobe laterally.Perilesiobal vasogenic area,massxeffect ,sub falcine herniation and mid line shift to left 9mm. MRI spectroscopy shows increase alanine peak& MRperfusion study shows elevated central and peripheral CBV and elevating peripheral CB V indicating an extra axial lesion. Imp: Parafalcine meningioma. Surgery done .Meningioma.Pt is well.

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Thanks Curofy and others. MRI brain shows * well defind large parafalcine heterogeneously enhancing extra axial lesion with few centeal and peripheral non enhancing area showing no diffusion restriction in DWI ,in the Rt frontal region ,minimal hemorrhagic changes within . * The lesion invaginate in to the Rt frontal lobe displacing the medial half of the Rt frontal lobe laterally.Perilesiobal vasogenic area,massxeffect ,sub falcine herniation and mid line shift to left 9mm. MRI spectroscopy shows increase alanine peak& MRperfusion study shows elevated central and peripheral CBV and elevating peripheral CB V indicating an extra axial lesion. Imp: Parafalcine meningioma. Surgery done .Meningioma.Pt is well.

Right Frontal ICSOL with perilesional edema with mass effect possibility of Astrocytoma Ddx - Brain abscesses

Astrocytoma with mass effect

It's ICSOL mam

Well defined, T2 hyperintense, intensely enhancing lesion, no significant restricted diffusion, perilesional edema +, thin fluid rim - meningioma originating from midline falx.

Rt frontal mass Midline shift to left Sol rt frontal extending to rt thalamic Opinion of neurosurgeon

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