Presentation
Right-sided weakness
Patient Data
The mass in the white matter at the right centrum semiovale demonstrates hypointensity on T1W and hyperintensity on T2W and FLAIR, with mild restricted diffusion. On T1 Gd+, the lesion shows open ring enhancement. On MRS imaging, it reveals an elevated peak of Choline, decreased NAA, and prominence with lactate.
After 2 months of corticosteroid treatment, the dimensions of the mass have decreased, and on T1 Gd+, the mass no longer shows enhancement. Additionally, perfusion imaging demonstrates a low relative cerebral blood volume
Case Discussion
In this case, the lesion primarily affects the white matter, demonstrating minimal mass effect or surrounding edema. It shows open ring enhancement and a low relative cerebral blood volume.
With the improvement in clinical examination and imaging of the patient, the diagnosis in this case is likely a tumefactive demyelinating lesion, especially after high-dose corticosteroid treatment.
Additionally, MRS imaging is not specific in this case.
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