Can you make a diagnosis?

The relative of a 62 years old male came to see me today with CT scan and MRI for seeking an opinion. 4 days back patient who was otherwise healthy previously, had episodes of giddiness and vomiting. According to relative he had no other symptoms. His chest X-ray is normal. I am posting pictures of NCCT and Contrast MRI head for you to make a diagnosis.

I will let you know what I found when I will operate him.

Replies to This Discussion

Permalink Reply by Abdulrahman J Sabbagh on April 24, 2010 at 10:35am

I could not see the image!

Permalink Reply by Karam Chand Sharma on April 24, 2010 at 11:39am

I opened the discussion on theneuronetwork.com and I can see CT and MRI images. I really do not know why you are not able to see them.

Permalink Reply by Carlos Fernando Lozano Tangua on April 24, 2010 at 4:55pm

Could be a case of giant and unique lesion of neurocisticercosis.

Sincerely:
Carlos Fernando Lozano Tangua
University of Cartagena

Permalink Reply by Carlos Delgado Hernandez on April 24, 2010 at 5:09pm

May be and infeccion; abscess

Carlos Delgado

Permalink Reply by Ihsan Solaroglu on April 25, 2010 at 5:55am

Looks like a hydatid cyst.

Permalink Reply by Dr.Nagesh C Shanbhag on April 25, 2010 at 7:08am

how do you differentiate between a cystic brain tumor and intracranial abscess(eg.bacterial)??
By MR Spec????

Permalink Reply by Karam Chand Sharma on April 25, 2010 at 10:38am

Tumours show increase choline/creatine ratio whereas abscess has lactate peak at 1.4 ppm, however spectroscopy is not 100% specific. Spectroscopy was the first application of NMR principal. The name NMR was changed because nuclear to public means radiation whereas MRI has no radiation.

Permalink Reply by Abdulrahman J Sabbagh on April 26, 2010 at 1:13pm

For some reason I could not see the images before... I see them now
Congratulations for excellent imaging workup
What is the background of this patient? Any risk factors?
One must think of Hydatid cyst, as the sympomatology is timid
Cystic tumors are an important differential diagnosis, and GBM in a 60 year old is always high in the differential diagnosis.
MRS hear s non specific, but at least we do not see necrosis (no high lip. & lact. peeks) or high chol. so it is unlikely to be a high grade tumor and also abscess is unlikely because of the symptomatology and MRS.
If you operate on this and you should, try to keep the cyst intact till the end of removal, one helpful way is to try to delineate the cleavage line between the cyst and the brain and then to use irrigation to separate the lesion from the brain , the a soft silicon tube can be used and slowly advanced under extreme caution to continue irrigating all the way till the whole cyst is delivered, (El-Khamlishi technique)
Good luck!