Concluded Case

High grade Glioma Rt Parasagittal periventricular region

72 yr old ,F, Presented with left sided weakness of 4 months. She developed progressive left sided weakness 1st started in the left leg. Also noted heaviness of left leg. No head ache,seizures, vomiting or vertigo. No symptoms regarding her Rt side. Known hypertensive for 10 yrs on losartan 50 mg . On exam : Normal vitals,BP 150/ 86 mmhg. Intact cranial nerves. Motor system gr4/ 5 left side with mild spasticity left side. Deep tendon reflexes were hyperactive left side with left extensor plantar with intact sensations. All routein blood work up including biochemistry were normal. MRI brain done. Patient is under the Neurosurgeon . Diagnosis and management.

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Concluded answer

Thanks Dr Anand for the appropriate answer. MRI shows fairly well defind lobulated T1 isiontense,T2W/ FLAIR hyperintense lesion with heterogeneous post contrast enhancement with non enhancing areas in the Rt parasagittal periventricular region and centrum semiovale of Rt frontoparietal line crossing the midline.perilesional edema seen causing mild effacement of adjacent sulcal space.MR perfusion shows increased central CBV Imp- Glioblastoma multiforme. Rt parietal craniotomy and decompression of tumor done using Neuro- navigation. HPR- High gr Glioma

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Thanks Dr Anand for the appropriate answer. MRI shows fairly well defind lobulated T1 isiontense,T2W/ FLAIR hyperintense lesion with heterogeneous post contrast enhancement with non enhancing areas in the Rt parasagittal periventricular region and centrum semiovale of Rt frontoparietal line crossing the midline.perilesional edema seen causing mild effacement of adjacent sulcal space.MR perfusion shows increased central CBV Imp- Glioblastoma multiforme. Rt parietal craniotomy and decompression of tumor done using Neuro- navigation. HPR- High gr Glioma

Thanks a lot mam.. Your elaborate discussion is excellent mam, learning a lot from you. Regards
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Heterogeneous density mass lesion involving right caudate, basal ganglia and protruding in to rt lateral ventricles Mitotic lesion as high vascularity noted in ASL sequence also As per location I keep possibility of ependymoma as 1st possibility followed by glioma Need surgical removal and +/- RT

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Rt. Side bleed with Rt. Ventricle compress

Thank you doctor
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