CNS Path diff diagnosis?

[MudPhud20XX]

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[Apoplexy__]

Haha, do we have any surrounding patient info? I'll say:
-Intraparenchymal abscess
-Intraparenchymal bleed
-Tumor/malignancy (cystic types)
-Neurocysticercosis

 

[Missorleans]

Yeah, need more info but I also like abscess or metastatic cancer. I feel like if it was a cystic mass it would be dark.

 

[MudPhud20XX]

thank you for the input. I just wanted to see you guys' thought processing....

yeah when I first saw this I thought the image and the clinical vignette did not match as I was thinking about tumor or some kind of abscess....

So is T2 weighted an important clue here too?

Here is the clinical vignette given:

1. a 50 yr old man with a past medical hx of including paresthesias, difficulty moving one or more extremities, loss of sensation, and ataxia over the past 22 years.
2. These problems have waxed and waned.
3. His brain T2-weighted MR image is shown.

 

[Apoplexy__]

thank you for the input. I just wanted to see you guys' thought processing....

yeah when I first saw this I thought the image and the clinical vignette did not match as I was thinking about tumor or some kind of abscess....

So is T2 weighted an important clue here too?

Here is the clinical vignette given:

1. a 50 yr old man with a past medical hx of including paresthesias, difficulty moving one or more extremities, loss of sensation, and ataxia over the past 22 years.
2. These problems have waxed and waned.
3. His brain T2-weighted MR image is shown.

Honestly, I'm not sure. I was thinking cystic/fluid because T2 makes fluids bright.

But that vignette sounds more like multiple sclerosis than anything else, unless I'm missing something. I suppose those white areas could be plaques.

 

[MudPhud20XX]

Honestly, I'm not sure. I was thinking cystic/fluid because T2 makes fluids bright.

But that vignette sounds more like multiple sclerosis than anything else, unless I'm missing something. I suppose those white areas could be plaques.

You got it Kirby! it's MS! btw, you are in the 3rd yr right? how is it going? how did your step 1 go?

 

[Apoplexy__]

You got it Kirby! it's MS! btw, you are in the 3rd yr right? how is it going? how did your step 1 go?

Ha, cool. I should have at least had MS in my differential...error on my part. But I guess it just goes to show that the vignette is far more helpful/important than the pathology pic.

Yep, MS3 now. I'll PM you!

 

[seminoma]

Haha, do we have any surrounding patient info? I'll say:
-Intraparenchymal abscess
-Intraparenchymal bleed
-Tumor/malignancy (cystic types)
-Neurocysticercosis

I see the answer is MS, but I would also throw PML on there (based on film alone).