Presentation
History of bladder cancer. Currently presents with headache.
Patient Data
Small cortical and subcortical ring-enhancing lesion is seen at the anterior aspect of the right temporal lobe. It elicits intermediate T2 and FLAIR signals and low T1 signal. It shows peripheral contrast enhancement in post-contrast study and shows diffusion restriction. It is surrounded by an ill-defined area of vasogenic brain edema pattern causing mild mass effect in form of effacement of underlying cortical sulci.
Normal size and parenchymal signal intensity pattern of the left cerebral hemisphere, cerebellum and brain stem.
Case Discussion
The ring enhancing lesion includes many differential diagnosis including:
metastases
abscess
glioblastoma
infarct (subacute phase) or inflammatory as tuberculoma
contusion
demyelinating lesions (incomplete rim of enhancement)
radiation necrosis
The presence of vasogenic edema and diffusion restriction in the presence of the clinical history of bladder cancer favors the diagnosis of a brain metastasis.
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