High grade astrocytomas are usually found in the cerebral white matter and make up 1/3 of all astrocytomas, with the remainder being low grade (I-II). They typically present from 40-60 years of age with seizures or focal neurologic deficit. They often have mixed signal characteristics and significant surrounding vasogenic edema. Calcification is uncommon. Metastasis is a consideration, however there would probably be lesions elsewhere in the CNS given the size of this tumor. Abscess is also in the differential. CNS lymphoma is a possibility only if the patient is immunocompromised since central necrosis is hardly ever seen in CNS lymphoma otherwise. Acute demyelination can sometimes mimick neoplasm and may also be a consideration. Related Cases
