Case Notes
History
76 yo female with known low grade brain tumor with recent onset of headacheExam
MR susceptibility (SWI)
Prior Study
CT Head pre contrast1. There is a single mass lesion (consistent with low grade tumor based on history) that has undergone recent hemorrhage necrosis the blood products evident in the dorsal anterior aspect of the tumor, which has released a small amount of blood into the ventricles. There is no secondary hydrocephalus.
2. The mass causes only local mass-effects with effacement of the left frontal horn but not the left cerebral aqueduct.
3. There is age-related ex vacuo ventriculomegaly and frontotemporal atrophic changes.
T1-w MR pre and post contrast
1. The left basifrontal intraaxial mass has contrast enhancement throughout. It has very distinct tumoral margin. The features are those of a low grade paraventricular brain tumor most consistent with low grade ependymoma.
2. There is evidence of some internal hemorrhagic necrosis, which is the source of the minimal intraventricular blood products.
T2-w spin echo
1. The spin echo T2-w sequence confirms the low grade nature of the left basifrontal mass and also indicates there has been intratumoral hemorrhagic necrosis.
MR flair
1. The MR flair also demonstrate changes of internal tumoral hemorrhagic necrosis with minimal intraventricular bleeding.
2. There is no transependymal fluid migration to suggest there is secondary hydrocephalus.