Case 375 Medical History A 59-year-old man presented with a one-month history of headache, reduced visual acuity, difficulty with balance and walking and intermittent episodes of memory loss. On examination, patient was alert, oriented, with right homonymous hemianopsia at confrontation testing of the visual field, lowering of the right lower limb during the Mingazzini manoeuver and right hemiparetic gait. Magnetic resonance image (MRI) of the brain is shown (Images 1-4). T1-weighted non-contrast-enhanced magnetic resonance image (MRI) of the brain, sagittalT2-weighted MRI of the brain, axial view.FLAIR MRI of the brain, axial view.T1-weighted contrast-enhanced MRI of the brain, axial view. Question:Considering the clinical and radiological findings, what is the most likely diagnosis? Glioblastoma Primary central nervous system lymphoma Brain abscess Brain metastases Test Question (CESPE-UnB – Medical Residency Examination, 2009). Nowadays, computed tomography (CT) and/or magnetic resonance image (MRI) are essential for diagnosis and monitoring of brain tumors. These imaging exams allow the description of some typical characteristics that influence even in the choice of the best area for biopsy. Regarding this subject, choose the right answer. Glial tumors behave similarly to normal parenchyma, that is, with focal tissue expansion and necrosis; however, without hemorrhage or enhancement; they are usually low grade lesions; Areas of necrosis should be chosen for biopsy in tumors; CT is superior to MRI for assessment of tumors in the posterior fossa; MRI is the exam of choice for patients with cardiac pacemakers; Enhanced tumors, hemorrhage and/or necrosis, in general, are those with the highest degree of malignancy and present infiltration of adjacent tissues, as classically occurs in glioblastoma. Time is Up! Time's up
