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Can you recognize the following 9 brain diseases? Yimaitong compiles and organizes, please do not reprint without authorization
.
Case 1 is a 26-year-old male patient.
He went to the doctor for 3 weeks due to progressive increase in confusion, agitation, and weakening of the sensory center
.
Imaging shows an enhanced mass along the transparent septum, extending to the inner side of the lateral ventricle, causing obstructive hydrocephalus, accompanied by occlusion of the temporal horn of the right ventricle
.
The sagittal image on the right shows the suprasellar space with enhanced lesions (yellow arrows)
.
Tandem lesions in the periventricular area and suprasellar space indicate central nervous system (CNS) germ cell tumors, but other pathologies, such as glioma and CNS lymphoma, are different
.
CNS germ cell tumors account for approximately 3% of all pediatric tumors
.
Although most are diagnosed in childhood, some may be discovered later, such as this patient
.
Case 2 is a 40-year-old male patient who suffered head injury and unconscious loss due to an accidental fall
.
A CT scan of the head showed a suspicious mass, and a gadolinium-contrast T1-weighted MRI showed a convex dural lesion on the left side, measuring 4.
5x4cm, and showing uniform enhancement
.
T1-weighted magnetic resonance imaging (MRI) scan of meningioma, showing axial (left) and coronal (right) views
.
Because the lesion was large and the patient was relatively young, a craniotomy was performed to remove all the lesions
.
Pathological tissue is consistent with World Health Organization (WHO) grade II meningioma
.
Meningioma is the most common primary intracranial tumor in clinical practice
.
According to the WHO classification, it can be divided into the following categories: ➤Grade I meningiomas account for 80-85% of meningiomas.
They are low-grade benign tumors with high progression-free survival rates and low overall mortality
.
➤Despite the maximum surgery and radiotherapy, the recurrence rate of grade Il (atypical) and grade I (anaplastic) meningioma is high
.
Case 3 is a 45-year-old man with a first epileptic seizure.
MRI of the brain showed intra-axial lesions in the temporal occipital lobe without any evidence of contrast enhancement
.
This is consistent with low grade (WHO grade ll) glioma
.
This is a highly invasive tumor that may develop into a malignant (WHO class II/V) lesion over time
.
If the patient is over 40 years old, they are usually considered to be at high risk of recurrence and can only perform less than total resection of the radiologically abnormal area
.
In low-risk patients, the survival benefit of adjuvant radiotherapy, chemotherapy, or both after gross resection has not been confirmed, and continuous MRI observation is still reasonable
.
Case 4 A 55-year-old male presented with progressive confusion and left hemiplegia
.
MRI showed a cystic mass with ring-shaped enhancement around it and a slight extension through the corpus callosum (single arrow)
.
The FLAIR sequence shows extensive vasogenic edema with shifted midline (dashed arrow)
.
Craniotomy was performed to remove glioblastoma (WHO grade IV glioma)
.
Glioblastoma is the most common primary brain tumor in adults.
The median survival time of patients is poor, at 15 months, and the 5-year survival rate is less than 2%
.
However, some factors may contribute to better results, such as isocitrate dehydrogenase 1 (IDH-1) mutation status, 06-methylguanine-DNA-methyltransferase (MGMT) methylation and tumor Location
.
Case 5 A 33-year-old woman suffered from progressive headache and persistent thirst despite drinking a lot of water
.
MRI proved to be a craniopharyngioma, and the suprasellar cystic lesions showed peripheral enhancement
.
Craniopharyngioma is a benign (WHO grade I) tumor that occurs in the sellar area and supra
.
Embryonic epithelium originates from Rathke's sac, which may have cystic or calcified components
.
Because of optic chiasm compression, they usually cause visual defects
.
Due to the interruption of the hypothalamic-pituitary axis, endocrine abnormalities (such as diabetes insipidus) can also be caused
.
Both subtypes of craniopharyngiomas tend to target different groups.
Ameloblastoma subtypes are most common in children, and papillary subtypes usually occur in adults
.
Case 6 is a 65-year-old female patient with progressive headache and numbness in her right arm for 2 months
.
MRI showed enhancement of the left parietal brain mass with peripheral vasogenic edema
.
A chest CT scan revealed a burr-like lung mass
.
Brain metastases are common in patients with lung cancer.
Compared with whole brain radiotherapy (WBRT), excision of solitary brain metastases in patients with non-small cell lung cancer (NSCLC) can improve survival and quality of life
.
Stereotactic radiosurgery (SRS) combined with WBRT has confirmed similar survival benefits for NSCLC
.
Brain metastases caused by SCLC are highly sensitive to radiotherapy.
Compared with radiotherapy alone, surgical resection has not been found to affect survival
.
Case 7 A 17-year-old man presented to the doctor with a progressive headache in the back of his head
.
The image below shows the left occipital cavernous malformation near the surface of the brain, showing the unique appearance of "popcorn" in the lesion
.
Histologically, cavernous vascular malformation is a low-pressure vascular malformation composed of multiple dilated thin-walled capillaries.
The cumulative bleeding rate during the lifetime is 1-4% per year
.
Cavernous vascular malformations are insidious on angiography.
Although they can manifest as headaches, epilepsy, or focal neurological deficits, they are usually discovered accidentally
.
Case 8 A 52-year-old female patient presented to the doctor with progressive confusion within 2 months, and then her neurological function deteriorated rapidly
.
CT scan (left) shows a high-density mass in the third ventricle with obstructive hydrocephalus
.
Subsequent MRI showed that the periventricular area and the multifocal enhancement area in the third ventricle (middle, solid arrow) blocked the lateral aqueduct (right, dashed arrow)
.
The imaging is most consistent with primary central nervous system lymphoma
.
Primary central nervous system lymphoma is an aggressive non-Hodgkin lymphoma
.
Most primary central nervous system lymphomas are diffuse large B-cell lymphomas, which can involve the brain, spinal cord, eyes, meninges, and cranial nerves
.
Currently, a chemotherapy regimen that includes high-dose IV methotrexate is considered the standard treatment and can achieve a high initial remission rate
.
Case 9 is a 30-year-old female patient.
She presented to the doctor because of worsening headache, nausea, and difficulty walking
.
MRI showed cystic lesions in CPA (left), without limitation of diffusion (right), and the results were consistent with arachnoid cysts
.
Normally benign arachnoid cysts are thought to be caused by abnormal arachnoid layer formation during embryo formation
.
However, in rare cases, abnormal cerebrospinal fluid flow can produce arachnoid cysts and cause them to enlarge, compressing the brainstem structure
.
Arachnoid cysts can occur in any part of the brain or spine; the most common site is the middle cranial fossa (>50%), followed by the posterior fossa
.
CPA arachnoid cysts usually present with ataxia, followed by headaches
.
Yimaitong compiled from: 10 Brain Lesions to Recognize.
Medscape.
October 25, 2021.
.
Case 1 is a 26-year-old male patient.
He went to the doctor for 3 weeks due to progressive increase in confusion, agitation, and weakening of the sensory center
.
Imaging shows an enhanced mass along the transparent septum, extending to the inner side of the lateral ventricle, causing obstructive hydrocephalus, accompanied by occlusion of the temporal horn of the right ventricle
.
The sagittal image on the right shows the suprasellar space with enhanced lesions (yellow arrows)
.
Tandem lesions in the periventricular area and suprasellar space indicate central nervous system (CNS) germ cell tumors, but other pathologies, such as glioma and CNS lymphoma, are different
.
CNS germ cell tumors account for approximately 3% of all pediatric tumors
.
Although most are diagnosed in childhood, some may be discovered later, such as this patient
.
Case 2 is a 40-year-old male patient who suffered head injury and unconscious loss due to an accidental fall
.
A CT scan of the head showed a suspicious mass, and a gadolinium-contrast T1-weighted MRI showed a convex dural lesion on the left side, measuring 4.
5x4cm, and showing uniform enhancement
.
T1-weighted magnetic resonance imaging (MRI) scan of meningioma, showing axial (left) and coronal (right) views
.
Because the lesion was large and the patient was relatively young, a craniotomy was performed to remove all the lesions
.
Pathological tissue is consistent with World Health Organization (WHO) grade II meningioma
.
Meningioma is the most common primary intracranial tumor in clinical practice
.
According to the WHO classification, it can be divided into the following categories: ➤Grade I meningiomas account for 80-85% of meningiomas.
They are low-grade benign tumors with high progression-free survival rates and low overall mortality
.
➤Despite the maximum surgery and radiotherapy, the recurrence rate of grade Il (atypical) and grade I (anaplastic) meningioma is high
.
Case 3 is a 45-year-old man with a first epileptic seizure.
MRI of the brain showed intra-axial lesions in the temporal occipital lobe without any evidence of contrast enhancement
.
This is consistent with low grade (WHO grade ll) glioma
.
This is a highly invasive tumor that may develop into a malignant (WHO class II/V) lesion over time
.
If the patient is over 40 years old, they are usually considered to be at high risk of recurrence and can only perform less than total resection of the radiologically abnormal area
.
In low-risk patients, the survival benefit of adjuvant radiotherapy, chemotherapy, or both after gross resection has not been confirmed, and continuous MRI observation is still reasonable
.
Case 4 A 55-year-old male presented with progressive confusion and left hemiplegia
.
MRI showed a cystic mass with ring-shaped enhancement around it and a slight extension through the corpus callosum (single arrow)
.
The FLAIR sequence shows extensive vasogenic edema with shifted midline (dashed arrow)
.
Craniotomy was performed to remove glioblastoma (WHO grade IV glioma)
.
Glioblastoma is the most common primary brain tumor in adults.
The median survival time of patients is poor, at 15 months, and the 5-year survival rate is less than 2%
.
However, some factors may contribute to better results, such as isocitrate dehydrogenase 1 (IDH-1) mutation status, 06-methylguanine-DNA-methyltransferase (MGMT) methylation and tumor Location
.
Case 5 A 33-year-old woman suffered from progressive headache and persistent thirst despite drinking a lot of water
.
MRI proved to be a craniopharyngioma, and the suprasellar cystic lesions showed peripheral enhancement
.
Craniopharyngioma is a benign (WHO grade I) tumor that occurs in the sellar area and supra
.
Embryonic epithelium originates from Rathke's sac, which may have cystic or calcified components
.
Because of optic chiasm compression, they usually cause visual defects
.
Due to the interruption of the hypothalamic-pituitary axis, endocrine abnormalities (such as diabetes insipidus) can also be caused
.
Both subtypes of craniopharyngiomas tend to target different groups.
Ameloblastoma subtypes are most common in children, and papillary subtypes usually occur in adults
.
Case 6 is a 65-year-old female patient with progressive headache and numbness in her right arm for 2 months
.
MRI showed enhancement of the left parietal brain mass with peripheral vasogenic edema
.
A chest CT scan revealed a burr-like lung mass
.
Brain metastases are common in patients with lung cancer.
Compared with whole brain radiotherapy (WBRT), excision of solitary brain metastases in patients with non-small cell lung cancer (NSCLC) can improve survival and quality of life
.
Stereotactic radiosurgery (SRS) combined with WBRT has confirmed similar survival benefits for NSCLC
.
Brain metastases caused by SCLC are highly sensitive to radiotherapy.
Compared with radiotherapy alone, surgical resection has not been found to affect survival
.
Case 7 A 17-year-old man presented to the doctor with a progressive headache in the back of his head
.
The image below shows the left occipital cavernous malformation near the surface of the brain, showing the unique appearance of "popcorn" in the lesion
.
Histologically, cavernous vascular malformation is a low-pressure vascular malformation composed of multiple dilated thin-walled capillaries.
The cumulative bleeding rate during the lifetime is 1-4% per year
.
Cavernous vascular malformations are insidious on angiography.
Although they can manifest as headaches, epilepsy, or focal neurological deficits, they are usually discovered accidentally
.
Case 8 A 52-year-old female patient presented to the doctor with progressive confusion within 2 months, and then her neurological function deteriorated rapidly
.
CT scan (left) shows a high-density mass in the third ventricle with obstructive hydrocephalus
.
Subsequent MRI showed that the periventricular area and the multifocal enhancement area in the third ventricle (middle, solid arrow) blocked the lateral aqueduct (right, dashed arrow)
.
The imaging is most consistent with primary central nervous system lymphoma
.
Primary central nervous system lymphoma is an aggressive non-Hodgkin lymphoma
.
Most primary central nervous system lymphomas are diffuse large B-cell lymphomas, which can involve the brain, spinal cord, eyes, meninges, and cranial nerves
.
Currently, a chemotherapy regimen that includes high-dose IV methotrexate is considered the standard treatment and can achieve a high initial remission rate
.
Case 9 is a 30-year-old female patient.
She presented to the doctor because of worsening headache, nausea, and difficulty walking
.
MRI showed cystic lesions in CPA (left), without limitation of diffusion (right), and the results were consistent with arachnoid cysts
.
Normally benign arachnoid cysts are thought to be caused by abnormal arachnoid layer formation during embryo formation
.
However, in rare cases, abnormal cerebrospinal fluid flow can produce arachnoid cysts and cause them to enlarge, compressing the brainstem structure
.
Arachnoid cysts can occur in any part of the brain or spine; the most common site is the middle cranial fossa (>50%), followed by the posterior fossa
.
CPA arachnoid cysts usually present with ataxia, followed by headaches
.
Yimaitong compiled from: 10 Brain Lesions to Recognize.
Medscape.
October 25, 2021.
