Brain Pathology Case of the Month - June 2001

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


CLINICAL HISTORY:

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.

GROSS DESCRIPTION:

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

MICROSCOPIC DESCRIPTION

FINAL DIAGNOSIS


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