Presentation
Young man with headache and left sided weakness.
Patient Data
Wedged shaped region of low density change in the right temporal lobe.
The CT hypodense lesion in the right temporal lobe corresponds to a FLAIR hyperintense mass lesion that involves both grey matter and white matter, with cortical thickening most notably involving the inferior bank of the superior temporal and superior bank of the middle temporal gyri. Areas of internal curvilinear enhancement are identified, some of which are likely meningeal/gyral. Associated diffusion restriction. No other intra-axial lesion is identified apart from a punctate focus of FLAIR hyperintensity in the left frontal subcortical white matter.
Conclusion: Findings are indeterminate and most likely represent a subacute infarct. A tumor could have similar appearances. Followup imaging will clarify.
6 week follow up scan
There has been a decrease in the extent of FLAIR signal abnormality within and around the superior and middle temporal gyri of the right temporal lobe. No progressive mass-effect is demonstrated. Increased T1 gyral cortical signal and minor enhancement is seen compatible with laminar necrosis. No hemosiderin staining on the susceptibility weighted images. The DWI has normalized.
Conclusion: Findings compatible with evolution of a right temporal infarct. Laminar necrosis is now evident.
Case Discussion
This case beautifully demonstrates how similar a primary brain neoplasm and subacute infarction can be on imaging. Follow up can make things clearer before getting surgical knives involved!
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