Answer to headache/seizure…

July 16, 2013

CNS, CT, Head, Head, MRI, Non-Trauma

A couple days ago I presented a middle-aged man with headache and seizure.  What type of imaging is this and what is your differential:

Cystic brain lesion CTT2 MRI cystic lesion

The top image is a non-contrast CT of the head.  The second image is an axial T2-weighted MRI of the head

Both images demonstrate a multi-cystic lesion in the left parietal area.  The MRI demonstrates significant surrounding edema.  A course differential for an intraparenchymal cystic brain lesion includes:

  • Parasitic infection (neurocysticercosis, hyatid cyst from Echinococcus granulosus)
  • Abscess
  • Tuberculosis
  • Neoplasm (craniopharyngioma, glioblastoma, metastases, and more…)
  • Enlarged periventricular spaces (Virchow-Robin spaces)
  • Benign cyst (e.g. neuroglial cyst)

I found a good article in Radiology that covers all types of brain cysts:

Osborn AG, Preece MT.  Intracranial Cysts:  Radiologic-Pathologic Correlation and Imaging Approach.  Radiology 239 (3); 2006.

Unfortunately I don’t have an answer to what this patient had, they are currently awaiting brain biopsy for further evaluation. 

Author:  Russell Jones, MD

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EMREMS: Radiology in Emergency Medicine

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