Case 272 -- Progressive Confusion Lethargy and Headaches

Contributed by J Barron MD1, SP Lownie MD2, DH Lee MD2, and RR Hammond MD1,2
  Departments of Pathology1 and Clinical Neurological Sciences2, University of Western Ontario
Published on line in June 2001


A 61 year-old female was found in her home moaning and unresponsive. She was taken to hospital where she was uncooperative and too obtunded to provide a history. According to her daughter there was a 3-week history of progressive confusion lethargy and headaches, and reduction in her spontaneous speech. On neurological examination she was disoriented and had a mild expressive aphasia. She was profoundly demented, unable to recognize her own daughter. Papilledema was noted as well as a right pronator drift.

Investigations included imaging of the head by CT and MRI (Figure 1), as well as cerebral angiography. A 5 cm. medial left frontal enhancing mass was identified. It distorted the frontal horn of the left lateral ventricle and inferiorly impinged on the left optic nerve. In addition, a large (2 cm) calcified partially thrombosed right carotid-ophthalmic artery aneurysm was noted. The patient underwent a left frontotemporal craniotomy and near-complete resection of the tumor, apart from a small portion adherent to the left anterior cerebral artery.


Intraoperatively the left frontal mass was bluish gray, firm and well demarcated from the adjacent brain.



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