Brain Tumor mimic And Optic Tract

CLINICAL INFORMATION:
Right Homonymous hemianopsia with normal carotid duplex.

TECHNIQUE:
Multiplanar, multisequence MR images of the brain without and with 7 mL of gadavist for intravenous contrast enhancement.

COMPARISON:
None available.

FINDINGS:
There is a approximate 8.6 cm region of signal abnormality in the left temporal lobe extending to the left side posterior limb internal capsule. It measures 6 x 5 x 6.5 cm, AP x width x craniocaudal dimension. The posterior and medial aspect of this lesion demonstrates ill-defined scattered irregular contrast enhancement. Some of the contrast enhancement extending along the cortical spinal tract on the left side. The anterior aspect of this lesion demonstrates low T1 signal and high T2 signal, suggestive of a high water content in this portion of the lesion. There is vasogenic edema and compression of the left lateral ventricle. There is approximate there is approximate 3 mm midline shift toward the right side.

No hemorrhagic transformation visualized. No evidence of restriction of diffusion to suggest acute stroke.

IMPRESSION:
1. 8.6 cm left temporal lobe lesion with vasogenic edema and 3 mm midline shift, likely represent primary brain cancer. Due to contrast enhancement is more prominent in the posterior and medial aspect of the lesion, this area likely represent the higher grade portion of the tumor.
2. The left-sided optic tract and the optic radiation traversed through this region of signal abnormality, likely affected by this lesion and explaining patient's right-sided homonymous hemianopsia. Neurosurgery and oncology consultation is recommended.