Brain Pathology Case of the Month - April 1999

Contributed by Cynthia Hawkins, MD, PhD1, Paul Muller, MD2, Juan M. Bilbao, MD1
     University Of Toronto, Departments of 1Pathology and 2Neurosurgery, St. Michael's Hospital, Toronto


A 44 year-old, male, electrical contractor presented with a three-month history of progressive headache and a two-week history of left-hand clumsiness and mild speech impairment. The morning of admission his headache worsened, he became drowsy and developed weakness of the left side of his body. On admission the patient was sleepy but arousable and oriented. There was evidence of left-sided hemiparesis, otherwise his general physical exam was unremarkable.


A non-contrast enhanced CT scan of the head revealed an heterogeneous mass with a hemorrhagic component occupying the right fronto-temporal region with midline shift and compression of the right lateral ventricle (Figure 1). At craniotomy the dura separated easily from the underlying brain, the superior gyrus of the temporal lobe was swollen and flattened and cerebrotomy produced an abnormal greyish friable tissue. Slightly deeper a large hematoma was evacuated leaving a 4 x 3 x 3 cm cavity. The patient went on to have post-operative radiation and chemotherapy but did not respond and died fourteen months later of tumour



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