Interparenchymal hemorrhagic neurocytoma: An atypical presentation of a rare CNS tumor
✍ Scribed by McCutchen, Thomas Q.; Smith, M. Timothy; Jenrette, Joseph M.; Van Tassel, Pamela; Patel, Sunil J.; Thomas, Charles R.
- Publisher
- John Wiley and Sons
- Year
- 1999
- Tongue
- English
- Weight
- 463 KB
- Volume
- 32
- Category
- Article
- ISSN
- 0098-1532
No coin nor oath required. For personal study only.
✦ Synopsis
The patient to be discussed today is a 48-year-old right-handed female visiting from England who was admitted to the neurology service with a 2-week history of worsening hemiparesis that had progressed to near hemiplegia just prior to admission. At the point of rapid deterioration she reported onset of a global headache. Past medical history was remarkable for several episodes of dizziness and right-sided numbness and weakness 1 year previously. MRI at that time reportedly revealed a nonenhancing mass and the patient was treated with antileptic drugs. Remaining past medical history and family, social, and work history were all unremarkable.
Physical examination revealed an awake and alert female with word-finding difficulty. She was appropriately oriented to time, place, and person and was able to provide a good history. Examination of the cranial nerves was unremarkable. She had a dense hemiparesis and upgoing toe on the right. There were no sensory deficits. The remainder of the physical examination was unremarkable. The neurologists ordered a CT scan and then an MRI. Dr. Van Tassel, could you please describe the radiographic findings for this patient?
Pamela Van Tassel, MD (Neuroradiologist)
CT scan and MRI following admission shows a hematoma with fluid levels in the left frontoparietal region. Associated with this hematoma is a homogeneously enhancing mass. The hemorrhage/mass complex extends from the dura to the deep parenchyma and has a large amount of associated edema with effacement of the lateral ventricle and sulci and a minimal amount of midline shift (Fig. ).
Dr. McCutchen.
At this point the patent was started on corticosteroids and the neurosurgeons were consulted. Considering the radiographic appearance this mass was felt to represent a glioblastoma, metastatic lesion, or very aggressive dural-based lesion. Following 36 hr of dexamethasone the patient had a slight improvement in her hemiparesis. She was taken to the operating room where a left parietal craniotomy and subtotal resection of the tumor and clot was done. Dr. Patel, how did the brain and tumor appear during surgery?