Case 344 Medical history Female patient, 48 years old, with progressive intermittent holocranial headache, bradipsiquism, spatial disorientation, slow walking, nausea and vomiting. Past medical history: Primary cancer of the right breast (T2N1, HER2+) diagnosed at the age of 42 and treated with mastectomy and adjuvant chemotherapy. Progression with recurrence in the left breast, lymph nodes and lung metastases, and liver nodules after two years of the underlying disease diagnosis. Requested magnetic resonance imaging (MRI) of the brain. Image 01: Magnetic resonance imaging (MRI) of the brain, T1-weighted, sagittal view at the level of the interhemispheric fissure, without contrast.Image 02: MRI of the brain, T1-weighted, with contrast. From the left to the right, axial reconstructions at the level of the bridge, the lateral ventricles and cranially to the lateral ventricles, respectively. Image 03: MRI of the brain, T2-weighted, without contrast. From the left to the right, axial reconstructions at the level of the bridge, the lateral ventricles (two central images) and cranially to the lateral ventricles, respectively. Question: After data analysis, the medical team raised the hypothesis of breast cancer brain metastases, opting for resection of one of the lesions. What complication presented in the images explains the conduct? Encephalitis Enlargement of the ventricular system Subarachnoid hemorrhage Midline shift Test question Pergunta: (UNIVERSIDADE FEDERAL DO PARANÁ – 2009) Com relação às metástases cerebrais, é CORRETO afirmar: Surgery and radiotherapy present better results in cerebral metastases treatment than chemotherapy. They are relatively malignant tumors and less common than the gliomas. Computed tomography is a more sensitive exam than the magnetic resonance imaging for diagnosing small injuries. The lung is the most common primary site, and the median survival of the patient with cerebral metastases is approximately 3 years. Cerebral metastases must be only biopsied and treated with whole brain radiotherapy. Time is Up! Time's up
