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Paper 2
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
There is a short differential for masses that cross the midline via the corpus callosum. Primary cerebral lymphoma tends to demonstrate uniform enhancement and diffusion restriction because it is hypercellular. Tumefactive multiple sclerosis can have similar appearances to GBM but given it is an isolated lesion GBM is the more likely diagnosis. Furthermore, enhancement in tumefactive multiple sclerosis is usually described as an open, rather than a complete ring. Metastases and toxoplasmosis, whilst often ring enhancing, very rarely involve the corpus callosum and cross the midline.
Short answer questions (SAQs)
Published in Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon, Radiology for Undergraduate Finals and Foundation Years, 2018
Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon
The CT head shows a 4 × 3 cm ring-enhancing lesion in the right frontoparietal region with surrounding oedema. In general, the low density centre is due to either avascularity (or low vascularity) or cystic degeneration. The ‘ring-enhancing’ edge is due to either hypervascular granulation tissue / hypervascular tumour capsule or increased permeability due to the breakdown of the blood-brain barrier (allowing leakage of contrast into the extracellular fluid space). Causes of ring-enhancing lesions include: Primary neoplasm: high grade glioma, lymphoma, leukaemia.Metastases.Infection: bacterial / tuberculous / fungal / parasitic abscess.Haemorrhagic-ischaemic lesion: resolving infarct, resolving haematoma, post surgical, thrombosed aneurysm.Demyelination: tumefactive multiple sclerosis.Drug-related.Radiation necrosis.
Neuro-Ophthalmic Literature Review
Published in Neuro-Ophthalmology, 2019
David Bellows, Noel Chan, John Chen, Hui-Chen Cheng, Peter MacIntosh, Sui Wong, Michael Vaphiades
Tumefactive multiple sclerosis (TMS) often presents a diagnostic challenge because it can mimic neoplastic, infectious, or ischaemic disease. The authors describe two patients with TMS with retinal findings of venous sheathing and bone spicule pigmentation. They note that retinal sheathing and uveitis is not uncommon in MS, however, retinal bone spicule pigmentation is rare in MS, especially in the tumefactive variety, which is in itself relatively uncommon.