Background: A demyelinating lesion can present as a space occupying lesion in Magnetic Resonance Imaging (MRI) brain. Lesions that have diameter greater than 2 cm is referred as tumefactive demyelinating lesion. These lesions can mimic a brain tumor, namely glioma or primary central nervous system lymphoma.
Case presentation: We present two female patients over 30 years old who presented with limb weakness. Their MRI demonstrated typical appearance of a solitary, incomplete rim enhancing lesion that involved the subcortical white matter with minimal mass effect. Also, the rim of enhancement opened to the grey matter. Due to their typical appearance, biopsy was not performed. The lesions in both patients reduced in size upon follow up after treatment commencement and currently recovering.
Conclusion: In this case report, we focus on discussing the MRI features of tumefactive demyelinating lesion and its main differentials, which are central nervous system lymphoma (CNSL) and glioma.
Hepatic encephalopathy is a neuropsychiatric spectrum, mainly caused by cirrhosis, portosystemic shunt, or portal hypertension. It is associated with poor survival and high recurrence rate without prompt initiation of adequate treatment. MRI can detect the extent of brain parenchymal injury and correlation to the patients’ clinical status is the utmost importance. Here we report a case of 42 years old man with underlying hepatitis C, with atypical presentation of parkinsonism in a classic MRI imaging findings of acute on chronic hepatic encephalopathy.
Germinoma arising from intracranial off-midline structures is considered ectopic. Although basal ganglia germinoma is a rare occurrence, it is more commonly seen in the Asian population, particularly among boys.Here, we report a case of an adolescent boy who presented with hemiplegia and delayed diagnosis of basal ganglia germinoma with progression on serial magnetic resonance imaging (MRI). Several signal changes have been described during the early stage of the disease such as T2-weighted patchy hyperintense signal, cerebral hemiatrophy, and signal change on susceptibility-weighted imaging. 11 C-methionine positron emission tomography is an additional imaging technique that can reveal ectopic germinoma. Follow-up MRI revealed small cystic changes, and the latest imaging showed progression into a large multicystic lesion with mass effect. The patient underwent surgery, and histopathological examination revealed basal ganglia germinoma. We highlight the serial MRI changes that were suggestive of basal ganglia germinoma in this case.
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