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Answer to headache/seizure…

July 16, 2013

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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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Middle-aged man with headache and seizure…

July 12, 2013

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Middle-aged man presents with headache and seizure:

Cystic brain lesion CT

T2 MRI cystic lesion

What type of imaging modalities are demonstrated above and what is your differential?

Answer to follow

Author:  Russell Jones, MD

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Brain Tumor…

April 25, 2013

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Here is an MRI head on a patient with a headache and newly diagnosed brain mass:

MRI brain tumor

This is a T2 weighted MRI.  T2 weighting is particularly good at showing edema.  Simple fluid enhances and appears bright on the image.  Above you can see the tumor arising near the peripheral parietal area with a good amount of surrounding bright fluid consistent with edema.  Note that the edema shows up similar to the patient’s normal CSF in the ventricles. 

If you add contrast to the study (gadolinium) and T1 weight the image this is what you’ll see:

Brain Tumor 2

In T1 weighted imaging simple fluid is darker but in this case the tumor outlines very well with gadolinium.  This imaging is particularly good at picking up smaller tumors without large amounts of surrounding edema.  In this case several other smaller lesions were easily identified with T1 gadolinium imaging including one seen in the midbrain:

Midbrain 1

These turned out to be a metastatic lesions likely from the lung.  Metastases are the most common clinically important brain malignancies found outside of the pediatric population (the exact incidence of non-clinically apparent. 

Author:  Russell Jones, MD

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