CT scan on 28/11/08
Findings: There is a broad based hyperdense mass in the right parietal region measuring 7.2cm X 4.9cm (axial) with medial buckling of the grey-white matter suggesting extra-axial mass. - significant mass effect resulting in effacement of ipsilateral lateral ventricle with minimal contralateral lateral ventricular dilatation. Midline shift of 12mm to the left. - homogenous enhancement with a small area of calcification. - small area of adjacent pressure erosion. No adjacent hyperostosis. - adjacent subtle white matter odema in the right parietal lobe. No mass is seen elsewhere. Basal cisterns are not obliterated.
IMP: Extra-axial mass in the right parietal region with significant mass effect.
DD: Meningioma.
MRI on 15/1/2009
MRI BRAIN WITH CONTRAST
There is a supra-tentorial, extra-axial, right fronto parietal mass which is hypointense on T1W, hyperintense with some ares of hypointensity representing calcification on T2W images. It enhances with contrast. The mass measures 5.1 ( Trans) x 7.5 ( AP) x 5.6 ( CC). It displaces the midline by 1.3 cm and compresses the ipsilateral lateral ventricle. Meningeal tail sign positive.
IMP: Appearances consistent with right fronto-parietal convexity meningioma.
He was advised for surgery but not keen. He was readmitted a month later with one episode of generalised tonic clonic seizure. He was started on phenytoin. In May 2009, he presented with behavioural changes and has been very aggressive. During this admission, the surgery was consented.
He was advised for surgery but not keen. He was readmitted a month later with one episode of generalised tonic clonic seizure. He was started on phenytoin. In May 2009, he presented with behavioural changes and has been very aggressive. During this admission, the surgery was consented.
PHYSICAL EXAMINATION General : GCS full
power of the lefty side - 4/5
power of the lefty side - 4/5
He underwent right frontoparietal craniotomy and tumour excision (Simpson's II) on 16/6/2009
Post-op he was extubated and recovered well.
Post-op CT scan on 17/6/2009
He was discharged well and planned for repeat MRI in 6 weeks.
1 comment:
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