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
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?
Me acuerdo perfectamente de esté caso , todos los días era el tema de todos los noticieros de la tele, nunca más apareció la Dra
Es un verdadero misterio.
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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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