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.
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.
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)