Case Notes
History
76 year old with male intermittent slurred speech and trouble with typing. Then developed acute arm weakness and staring spell with unresponsiveness. Patient had a full head MR exam, which was interpreted as having features of acute stroke. No dominant mass was identified to suspect CNS tumor. Based on the imaging and the acute right arm paresis, the patient underwent angiography for possible stroke therapy; the angio, however, was negative. The patient was then referred as an unknown diagnostic problem.Exam
MR diffusion
Prior Study
CT Head was not obtained.MR T1-w exam
There is evidence of a diffusely infiltrative process apparently arising in the left parietotemporal area with extension to the left insula, the left orbitofrontal area and possibly the contralateral frontal periventricular region. These findings are most consistent with malignant gliomatosis. There is tumor in the subcortical left motor area, which if generating a seizure would account for the patients acute arm paresis and starring spells.
T2-w MR
Diffuse mainly white matter T2-w signal change combined with mulinodular enhancement is most consistent with malignant gliomatosis.