- Email: [email protected]
A patient with confusion and dizziness
Journal of Clinical Neuroscience 19 (2012) 1281
Contents lists available at SciVerse ScienceDirect
Journal of Clinical Neuroscience journal homepage: www.elsevier.com/locate/jocn
Images in Neuroscience: Question
A patient with confusion and dizziness Aiesha Ahmed a,⇑, Charles Specht b, Max R. Lowden a a b
Department of Neurology, Penn State University, 30 Hope Drive, EC 037, Hershey, PA 17033, USA Department of Pathology, Penn State University, Hershey, PA, USA
1. Clinical background A 45-year-old otherwise healthy man presented with sudden onset of confusion and dizziness. His neurological examination revealed a somnolent man who was oriented to person and place and could follow simple commands. A brain CT scan with contrast (Fig. 1) showed a hypodensity involving the right frontal and anterior parietal lobes with resultant compression of the right lateral ventricle and leftward midline shift. A brain MRI without contrast (Fig. 2) showed a right frontoparietal-enhancing lesion with associated vasogenic edema. Laboratory testing revealed a positive result for human immunodeficiency virus (HIV). 2. The most likely diagnosis is A. B. C. D.
HIV-related central nervous system lymphoma Toxoplasmosis Cryptococcoma Progressive multifocal leukoencephalopathy.
Fig. 1. Post-intravenous contrast, axial brain CT scan showing white matter hypodensity involving the right frontal and anterior parietal lobes with resultant compression of the right lateral ventricle and leftward midline shift.
Answer on page 1330.
Fig. 2. Brain MRI (A–C, axial; D, coronal) (A) axial T1-weighted with gadolinium, (B) T1-weighted without gadolinium, (C) T2-weighted, and (D) T1-weighted with gadolinium showing a hypointense, enhancing heterogeneous mass involving the right frontoparietal lobe, measuring 2.2 cm 3.0 cm, with surrounding vasogenic edema and mass effect on the right lateral ventricle with associated leftward midline shift.
DOI of answer: http://dx.doi.org/10.1016/j.jocn.2011.07.049
⇑ Corresponding author. Tel.: +1 717 531 1377; fax: +1 717 531 0384. E-mail address: [email protected] (A. Ahmed). 0967-5868/$ - see front matter Ó 2011 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jocn.2011.07.037
Contents lists available at SciVerse ScienceDirect
Journal of Clinical Neuroscience journal homepage: www.elsevier.com/locate/jocn
Images in Neuroscience: Question
A patient with confusion and dizziness Aiesha Ahmed a,⇑, Charles Specht b, Max R. Lowden a a b
Department of Neurology, Penn State University, 30 Hope Drive, EC 037, Hershey, PA 17033, USA Department of Pathology, Penn State University, Hershey, PA, USA
1. Clinical background A 45-year-old otherwise healthy man presented with sudden onset of confusion and dizziness. His neurological examination revealed a somnolent man who was oriented to person and place and could follow simple commands. A brain CT scan with contrast (Fig. 1) showed a hypodensity involving the right frontal and anterior parietal lobes with resultant compression of the right lateral ventricle and leftward midline shift. A brain MRI without contrast (Fig. 2) showed a right frontoparietal-enhancing lesion with associated vasogenic edema. Laboratory testing revealed a positive result for human immunodeficiency virus (HIV). 2. The most likely diagnosis is A. B. C. D.
HIV-related central nervous system lymphoma Toxoplasmosis Cryptococcoma Progressive multifocal leukoencephalopathy.
Fig. 1. Post-intravenous contrast, axial brain CT scan showing white matter hypodensity involving the right frontal and anterior parietal lobes with resultant compression of the right lateral ventricle and leftward midline shift.
Answer on page 1330.
Fig. 2. Brain MRI (A–C, axial; D, coronal) (A) axial T1-weighted with gadolinium, (B) T1-weighted without gadolinium, (C) T2-weighted, and (D) T1-weighted with gadolinium showing a hypointense, enhancing heterogeneous mass involving the right frontoparietal lobe, measuring 2.2 cm 3.0 cm, with surrounding vasogenic edema and mass effect on the right lateral ventricle with associated leftward midline shift.
DOI of answer: http://dx.doi.org/10.1016/j.jocn.2011.07.049
⇑ Corresponding author. Tel.: +1 717 531 1377; fax: +1 717 531 0384. E-mail address: [email protected] (A. Ahmed). 0967-5868/$ - see front matter Ó 2011 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jocn.2011.07.037