Intracranial mass in a patient with leukemia: question

Abstract

A 48-year-old woman with history of hypertension, diabetes mellitus, hyperlipidemia, and myeloid leukemia, on nilotinib chemotherapy following a recent blast crisis, presented as a presumed stroke with altered mental status, left upper extremity weakness, nausea, and vomiting. The patient was reportedly normal approximately 12 hours prior. At the time of examination, the patient was drowsy and unable to corroborate her own history. She was able to answer appropriately for date, name, and commands. Speech was dysarthric. Motor testing of extremities demonstrated 5/5 strength in the right extremities, 2/5 strength in the left extremities, with a left facial droop. Initial imaging demonstrated a hyperdense, likely hemorrhagic, ovoid mass along the right frontotemporal convexity (Fig. 1). MRI of the brain demonstrated a 4.7 Â 2.7 cm enhancing dural-based lesion along the right convexity (Fig. 2). The most likely diagnosis isA. Dural-based metastasis B. Intracerebral hemorrhage C. Granulocytic sarcoma (chloroma) D. Atypical meningioma Answer on page 207. Fig. 1. Axial CT scan of the brain demonstrates a large, hyperdense ovoid mass along the right frontotemporal convexity with associated vasogenic edema and midline shift. Fig. 2. (A) T1-weighted post-contrast axial MRI demonstrates a 4.7 Â 2.7 cm enhancing dural-based lesion along the right frontotemporal convexity. (B) T2-weighted axial MRI demonstrates significant vasogenic edema and midline shift with partial ventricular effacement. (C) Axial diffusion-weighted MRI demonstrates the same hyperintense lesion. http://dx.