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| T1 axial pre gad | T1 axial post gad | T1 coronal post gad |
Diagnosis: Glioblastoma multiforme
Glioblastoma multiforme is the most common primary CNS tumor and makes up 1/2 of all astrocytomas. Patients typically present over the age of 50 with seizures or focal neurologic deficit. The most common location is in the deep white matter of the cerebral hemispheres. They are unusual in the posterior fossa. Glioblastoma multiforme is usually a ring enhancing mass with a thick, shaggy wall and a centrally necrotic portion with mass affect and surrounding vasogenic edema. Small hemorrhages may be present while calcification and gross hemorrhage are unusual. They usually have heterogeneous signal on MR with irregular ring enhancement. GBMs may spread along the leptomeninges, the ependyma, white matter tracts or by CSF seeding into the subarachnoid space. Metastases outside the CNS and dural invasion are rare. A single metastasis of the this size is unusual. If the patient had systemic symptoms, cerebral abscess is a possibility. The periventricular location is good for lymphoma; however, lymphoma typically does not have central necrosis unless the patient is immunocompromised. Acute demyelination may produce an aggressive radiographic appearance and may be considered when appropriate. Given the age of the patient, the clinical history, and the radiographic appearance, GBM is the best diagnosis. Related Cases
