Hola amigos, el caso de hoy corresponde a una mujer de 54 años con cefalea vespertina, sensación de inestabilidad y episodios de minutos de evolución de afasia motora, a lo largo de los últimos seis meses. Exploración física y neurológica sin alteraciones.
¿Cuál sería el diagnóstico?
1. Metástasis dural
2. Tumor fibroso solitario
3. Meningioma
4. Hemangiopericitoma
Podéis dar vuestra opinión hasta el viernes, día en el que se publicará la solución.
Imágenes de TC craneal sin contraste (A) y con contraste endovenoso (B), y con ventana de hueso (C)
Haz click aquí para ver la respuesta
Hallazgos: masa extraparenquimatosa situada en la convexidad hemisférica cerebral fronto-temporal izquierda, isodensa en relación al parénquima cerebral (A) con un intenso y homogéneo realce tras la administración de contraste e.v (B), y un ribete medial a la masa hipodenso (asteriscos A-B). Hiperostosis focal en la calota craneal adyacente (C) en relación a la presencia de un spur enostótico (flecha).
Diagnóstico definitivo: meningioma cordoide.
Imágenes de RM craneal en el plano axial y secuencias T1, T2 Y T1 con contraste (A, B, C) y en el plano coronal y secuencias FLAIR (D) y T1 con contraste endovenoso (E). Se incluye estudio de espectroscopia univoxel eco largo (F).
Masa extraparenquimatosa situada en la convexidad hemisférica cerebral fronto-temporal izquierda, isointensa en T1 en relación al parénquima cerebral (A), hiperintensa en T2, con imágenes lineales de baja señal en su interior por la presencia de vasos intratumorales (B). Intenso realce tras la administración de contraste e.v, con realce dural lineal en el margen posterior de la lesión (flecha en C). Ribete periférico y medial a la masa hipointenso en T1, sin y con contraste, e hiperintenso en T2/FLAIR, en relación a loculaciones de LCR atrapado en el espacio subaracnoideo (asteriscos). El estudio espectoscrópico muestra el patrón de metabolitos característico del meningioma: pico de colina, mínima presencia de N-acetilaspartato y doblete invertido de alanina en la posición 1.5 (flecha, F).
HISTOPATOLOGÍA
Fragmento hístico de siete centímetros de diámetro máximo, consistencia elástica y aspecto granular, y de color terroso con focos hemorrágicos.
MENINGIOMA: SEMIOLOGÍA RADIOLÓGICA
Meningioma convexidad
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Meningioma
….la presencia de un área hipo densa y ángulos agudos de contacto me hacen descartar meningioma, el realce con el contraste podría corresponder a hemangiopericitoma….creo, veremos que dirá el Dr. Pepe. Saludos
Hemangiopericitoma
tumor fribroso solitario meningeo
hemangiopericitoma
Meningioma
The presence of a hypodense area and sharp contact angles lead me to believe that hemangiopericytoma is more likely than meningioma. On the other hand, the contrast enhancement may be indicative of hemangiopericytoma. I believe that we should wait to hear what Dr. Pepe has to say. Greetings
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Given the symptoms described, especially the evening headaches and episodes of motor aphasia, my guess would lean towards meningioma.
I’m also a doctor so I can confirm that the diagnoses you gave are correct.
Additionally, as a medical professional, I can verify the accuracy of the diagnoses provided.
Based on the presenting symptoms and the absence of abnormal findings on physical and neurological examination, along with the progressive nature of the symptoms over six months, the most likely diagnosis would be meningioma.
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Los meningiomas son tumores generalmente benignos que se originan en las capas de tejido que cubren el cerebro y la médula espinal (las meninges). Pueden causar síntomas como cefalea, cambios en la función cerebral dependiendo de su ubicación, y pueden crecer lentamente a lo largo del tiempo.
¿Cuál es la conclusión final de este diagnóstico?
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En este caso, la combinación de cefalea vespertina, sensación de inestabilidad y episodios de afasia motora en una mujer de 54 años es muy preocupante y sugiere la posibilidad de un proceso intracraneal significativo. Personalmente, creo que un meningioma podría ser una de las explicaciones más probables, ya que estos tumores pueden presentarse con síntomas neurológicos sutiles y progresivos. Estoy ansioso por conocer la respuesta final, ya que estos casos siempre brindan una gran oportunidad para aprender y reflexionar sobre el diagnóstico diferencial.
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Personally, I believe that a meningioma could be one of the most likely explanations, since these tumors can present with subtle and progressive neurological symptoms.
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Vaya detalle interesante, la masa extraparenquimatosa en la convexidad del hemisferio cerebral me llama la atención. Me hace pensar en un meningioma, sobre todo considerando el realce intenso tras el contraste. Mientras esperas el diagnóstico, ¿por qué no disfrutar de una lectura ligera en el metro? ¡Qué intriga!
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The description of the lesion, particularly the intense and homogeneous enhancement post-contrast and the adjacent hyperostosis with an enostotic spur, strongly points towards a meningioma. While the initial symptoms of motor aphasia and instability are concerning, the imaging findings seem quite classic for this type of tumor. I’m curious about the significance of the hypodense medial rim noted in the CT scans – is that a common feature with meningiomas, or something that might suggest a differential diagnosis? The definitive diagnosis of a chordoid meningioma is interesting; I haven’t encountered that subtype as frequently.
The description of the medial hypodense ribbing and the adjacent cranial hyperostosis with an enostotic spur really pointed towards a meningioma, even before seeing the definitive diagnosis. I was initially considering other possibilities based on the symptoms like intermittent motor aphasia, but the imaging findings are so characteristic. It’s interesting how the cordoid subtype can present. I’ve worked with a lot of structural projects, and sometimes the way materials interact, like bone spurring from a mass, is a clear indicator of what’s going on. This case really highlights the importance of detailed imaging analysis.
The description of a hypodense medial ribete is an interesting detail given the eventual diagnosis of meningioma. I was initially leaning towards a hemangiopericitoma myself, especially with the history of headaches and instability, which can sometimes point to vascular lesions. The hyperostosis on the CT is a strong clue, but I’ve seen that with other dural-based tumors too. It’s fascinating how subtle imaging findings can lead to such distinct diagnoses. Thanks for walking us through this case!
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The hyperostosis noted on the CT, particularly the enostotic spur, is such a classic sign that it made me lean towards meningioma immediately. It’s fascinating how these tumors can directly affect the adjacent bone. While the initial symptoms of motor aphasia were a bit concerning and could point to other things like metastasis, the clear extraparenchymal location and the imaging characteristics really solidified it for me. The cordoid subtype is also interesting – I’ve read it can have a slightly different appearance sometimes, but the enhancement pattern here was very typical. Good case!
The description of the lesion’s appearance on CT, particularly the hyperostosis with the enostosis spur on the adjacent calvarium, strongly suggested a meningioma even before the definitive diagnosis. I found the detail about the medial hypodense rim around the mass interesting. Was that a dural tail sign, or something else specific to this subtype? It’s fascinating how these tumors can present with such subtle yet telling radiological features. The patient’s symptoms of intermittent motor aphasia and instability are also a good reminder of how mass effect can manifest.
The description of the lesion’s location and its presentation with a hyperostosis spur on the CT scan really pointed towards meningioma for me. I was leaning towards that from the start, though the other options did make me think twice. It’s interesting how the hypodense medial rim on the CT and the subtle findings on the MRI can be so crucial in differentiating these types of tumors. It reminds me a bit of trying to spot the subtle differences in enemy patterns in a fast-paced arcade game – one wrong move and you miss it. Glad it was resolved clearly!
The description of a lesion with an intense, homogeneous enhancement after contrast and focal hyperostosis on the skull, as seen in the CT images, strongly points towards a meningioma. The “spur enostótico” is a classic sign. While a hemangiopericytoma can also enhance, the hyperostosis isn’t as typical, and the description of the lesion’s relationship to the dura seems more consistent with a meningioma. The mention of a “ribete medial a la masa hipodenso” is an interesting detail that perhaps suggests some dural thickening or an inflammatory component, but the overall picture leans heavily towards meningioma.
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The description of the hyperostosis and the enostotic spur on the cranial CT really points towards a meningioma, especially given the location. I was initially thinking about a metastatic lesion due to the symptoms, but the imaging findings here are so classic for a meningioma. The prompt mentioned a “ribete medial a la masa hipodenso,” which is also a typical sign described for meningiomas, often representing a dural tail. It’s interesting how subtle these imaging clues can be, yet so definitive when you know what to look for. The final diagnosis of a chordoid meningioma is also a good reminder of the diverse subtypes that exist.
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The description of the lesion, particularly the “intenso y homogéneo realce tras la administración de contraste e.v” and the adjacent “hiperostosis focal en la calota craneal adyacente,” strongly pointed towards a meningioma. I was curious about the specific subtype, “cordoide,” mentioned in the solution. Is this a common presentation for cordoide meningiomas, or does it have unique imaging features that would distinguish it from other meningioma subtypes on these scans? It’s fascinating how subtle imaging details can lead to such precise diagnoses.
The description of the hypodense medial ribbing around the mass on the CT scan, along with the focal hyperostosis and enostotic spur, really points strongly towards a meningioma. It’s interesting how these subtle imaging findings are so crucial for differentiating from the other options. I’ve seen how even a slight change in bone can be a big clue in diagnosing these types of lesions. The cordoid subtype is a bit less common, so it’s good to see a case highlighting it.
The hyperostosis on the bone window CT is a really classic sign. I was leaning towards meningioma given the location and enhancement pattern, but that bony change solidified it for me. It’s interesting how the “spur enostótico” points so directly to a dural-based lesion like that. The description of the mass being isodense on pre-contrast CT and then enhancing so brightly is also very typical for meningiomas. I’ve seen a few cases where the hyperostosis was the most striking feature, even before the mass itself was fully appreciated.
The description of the “ribete medial a la masa hipodenso” and the adjacent hyperostosis really points towards a meningioma, as you’ve shown. I was initially considering a solitary fibrous tumor, but the classic hyperostosis on the CT is a strong indicator. It’s fascinating how these tumors can present with such varied neurological symptoms, like the motor aphasia here. Makes you appreciate the complexity of the brain and the subtle clues imaging can provide.
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