Concluded Case

Right frontal parasagittal high grade glioma.

New case 42 yr ,M, presented with one episode of left sided focal fit starting from left lower limb on 26 th of last month.Focal fit lasted for 10 mts and he developed left sided weakness soon after the fit. SINCE THEN HAVING ALMOST CONTINUOUS IRRITATING TYPE OF HEADCACHE ON THE RT SIDE OF HEAD. No vomiting. No previous history of seizures or any medical illness. On exam vitals stable. Normal higher functions and speech . Normal optic fundi. Mils obliteration of left nasolabial fold. Motor system gr 3/ 5 left side with DTRs +++,with rxyensor plantar lt side . Intact sensations. What abnormality in theMRzi brain?

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Concluded answer

Thanks to all doctors who answered the case. Discussion - What abnormality in the MRI. MRI shows large heterogeneously enhancing irregylarly marinated intra axial lesion showing solid and cystic components in the Rt frontal parasagittal location with areas of necrosis and hemorrhage. Adjacent large non enhancing cystic lesion which is likely represent peritumoral cyst and significant perilesional white matter edema and mass effect. possibilities include 1.Glioblstoma multiforme, 2. Metastasis. Surgery done .HPR - High gr Glioma. Ref to Oncologist also.

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Thanks to all doctors who answered the case. Discussion - What abnormality in the MRI. MRI shows large heterogeneously enhancing irregylarly marinated intra axial lesion showing solid and cystic components in the Rt frontal parasagittal location with areas of necrosis and hemorrhage. Adjacent large non enhancing cystic lesion which is likely represent peritumoral cyst and significant perilesional white matter edema and mass effect. possibilities include 1.Glioblstoma multiforme, 2. Metastasis. Surgery done .HPR - High gr Glioma. Ref to Oncologist also.

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Para-sagittal SOL with midline shift and left hemiparesis with exaggerated DTR's...... Most important differential is Meningioma Trans-arterial embolization f/b Resection is required

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Heterogenous sol ( comprising of solid and cystic components with intralesional calcification and haemorrhage ) in frontal region with perilesional brain oedema, peritumoral cyst formation and significant mass effect. The mass having bradbased dural attachment at places . Possibility _1. Atypical parasagittal meningioma 2. Butterfly glioma

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A large irregular mass involving Frontoparietal region with compression of anterior horn of right ventricle with midline shift with surrounding oedema, DIAGNOSIS - GBM

Sol in brain stem region Aneurysm of cerebral artery Tubeculoma Neurocystisatcosis Midline shift to left Hydrocephalus Opinion of neurologist

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Rt fronatl parasagital mass with mixed density and significant edema and midline shift D/d would be parasagital meningioma, high grade glioma Need surgical removal with AEDs

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rt frontal lesion..at this age granuloma or high grade glioma ..mets is another possibility

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Rt frontal gbm with edema&midline shift. 1st possibility gbm. Advised surgery. Radio&chemo.

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Adtrocytoma

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