Acute lymphocytic leukemia with cavernous sinus and subependymal spread
Presentation
Known case of acute lymphocytic leukemia with CNS involvement and thrombocytopaenia complaining of severe headache. Prior chemo- and radiotherapy.
Patient Data
Ring artefact degrading image quality.
Diffuse white matter hypoattenuation is seen.
Multifocal partially defined hyperattenuating lesions are seen in the subependymal region of the third ventricle as well as both CP angles near the origin of the trigeminal nerve bilaterally extending to both cavernous sinuses.
VP shunt is seen traversing the right frontal region.
Heterogeneously enhancing tissue expands the pineal region. Additionally, both cavernous sinuses are expanded by similarly enhancing soft tissue extending posteriorly along the anterior tentorial edge.
Diffusely abnormal white matter with high T2 and FLAIR signal intensity representing leukoencephalopathy related to the patient's history of chemotherapy and radiotherapy.
Ventricular catheter with a reservoir in situ indicates intrathecal chemotherapy.
Case Discussion
The patient is a known case of acute lymphocytic leukemia (ALL), he was presented to the ER with acute headache and low platelets. Brain hemorrhage was suspected. Although the appearance may mimic intraventricular hemorrhage, the well-organized shape, site and pattern of distribution of this hyperattenuating lesion suggests recurrent tumor.
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