Dr. Pepe’s Diploma Casebook: Case 30 – SOLVED!


Dear Friends,

Showing MRI images of an 82-year-old woman with partial motor seizures afecting her face.

1. Metastasis
2. Meningioma
3. Multiple myeloma
4. None of the above


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    19 Responses to : Dr. Pepe’s Diploma Casebook: Case 30 – SOLVED!

    1. Paula says:


    2. LL says:

      subdural lesion in the right frontopariteal region
      medium signal intensity on both T1 and FLAIR
      extensive neighbouring edema visible on FLAIR
      dural tail is visible on Gd enhanced images
      no necrotic or cystic change
      [in addition: some small, diffuse hyperintensive lesions on FLAIR bilaterally (lacunar lesions?)]

      the signs suspect for:

      further MRS can confirm the findings

    3. him says:

      edema and mass effect is not typical for meningioma..
      it may be associated with atypical meningioma.

      considering age, dural base extra axial lesion with intense homogenous enhancement, skull vault invasion and edema …p/o metastasis is more likely

    4. him says:

      hemingiopericytoma is also a differential

    5. Maria says:

      Probably meningioma with mass effect and reactive bone hyperostoses

    6. maria says:


    7. Оlga says:


    8. genchi bari italia says:

      Massa , a sede intra-assiale( no meningioma) , sovratentoriale, isointensa in T1 con ipointensità circostante da edema vasogenico ed effetto-massa sulventricolo laterale. In FLAIR, la massa appare modicamente iperintensa rispetto al t. cerebrale sano e si delimita meglio l’edema vasogenico; comparsa di minute immagini iperintense in entrambi gli emisferi. Dopo Gd e.v.intenso c.e. non omogeneo per aree colliquative-necrotiche.Non mieloma multiplo . Probabile linfoma cerebrale.

    9. fahd says:

      malignant meningioma.

    10. Pequeño saltamontes says:

      Multiple myeloma

    11. Albert says:

      Dural tail and bone hyperostosis, both present, have been described as the most reliable morfological findings to make the diagnosis of meningioma. More over the sex and the age fits with it.

      Advanced MRI techniques could be helpful: alanine on the spectroscopy and charactetistic very high perfusion are almost patognomonic of meningiomas.

      With this images, I would strongly suggest MENINGIOMA.

    12. Burak says:

      Lentomeningial metastasis
      I hope that ı Will give the only answer

    13. vijay kumar ichpujani says:


    14. gus says:


    15. banu says:

      Leptomeningeal metastaz

    16. Gianpy says:

      linfoma primitivo del SNC (PCNSL)

    17. Ricardo Macareno says:


    18. Shaista says:

      Extra axial mass in fronts parietal location showing dural tail on post contrast images likely meningioma