Question 466
{"accessible":true,"alternatives":[{"id":2337,"text":"cerebral metastasis"},{"id":2338,"text":"CNS lymphoma"},{"id":2339,"text":"demyelination"},{"id":2340,"text":"glioblastoma"},{"id":2341,"text":"radiation necrosis"}],"archived":false,"correctAlternativeId":2340,"explanation":"\u003cp\u003eThis is the typical appearance of a butterfly glioma. Although all the other options are reasonable differentials, the central non-enhancement would be unusual for lymphoma. Demyelination is uncommon in this demographic and usually has incomplete peripheral enhancement. Radiation necrosis only occurs after (you guessed it) radiation, and in an \"otherwise well\" individual is not likely. Metastases are certainly common in the elderly and not infrequently are the first presentation of disease. Crossing the corpus callosum is, however, most unusual.\u003c/p\u003e","id":466,"imageUrl":"https://prod-images-static.radiopaedia.org/multiple_choice_questions/783/glioblastoma-nos-butterfly-morphology_big_gallery.jpeg","imageAttribution":{"kind":"case","rID":2589},"imageAttributionCaseInfo":{"title":"Glioblastoma NOS (butterfly morphology)","contributor_name":"Frank Gaillard","contributor_param":"frank","case_rid":2589,"case_param":"glioblastoma-nos-butterfly-morphology"},"firstQuestionPath":"/questions/598","nextQuestionPath":null,"relatedArticles":[{"id":4924,"title":"Brain metastases","link":"/articles/brain-metastases?lang=us"},{"id":4910,"title":"Glioblastoma, IDH-wildtype","link":"/articles/glioblastoma-idh-wildtype?lang=us"},{"id":1032,"title":"Lymphomas of the central nervous system","link":"/articles/lymphomas-of-the-central-nervous-system?lang=us"},{"id":1026,"title":"Butterfly glioma","link":"/articles/butterfly-glioma?lang=us"},{"id":2225,"title":"Tumefactive demyelinating lesion","link":"/articles/tumefactive-demyelinating-lesion?lang=us"},{"id":43344,"title":"Glioblastoma vs cerebral metastasis","link":"/articles/glioblastoma-vs-cerebral-metastasis?lang=us"}],"alsoUsedIn":[],"stem":"\u003cp\u003eAn elderly, otherwise well, individual presents with a\u0026nbsp;headache and is investigated with an MRI. What is the most likely diagnosis?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/466"}],"attemptsPercentages":[{"alternativeId":"2338","percentage":6},{"alternativeId":"2339","percentage":2},{"alternativeId":"2341","percentage":1},{"alternativeId":"2337","percentage":2},{"alternativeId":"2340","percentage":89}],"promptToLogin":false,"questionManager":false,"articleId":"cerebral-radiation-necrosis"}