Case 17

Case 17 Multiple brain lesions

Figure 17: MRI T1 with contrast.

Clinical presentation

  • Male patient 63 years with 3 months the condition has started 2 months ago with recurrent attacks of mild diffuse dull aching headache, dizziness & generalized fatigue aggravated 10 days ago with DCL and speech difficulty.

  • Q1: Which of the following tumors is most likely to have prominent flow voids?
  1. Cerebral metastasis.
  2. Glioblastoma.
  3. Hemangioblastoma.
  4. Medulloblastoma.
  5. Pilocytic astrocytoma.
  • Hemangioblastoma

  • Q2: What percentage of cerebral metastases are solitary at the time of presentation?
  1. 5%
  2. 25%
  3. 50%
  4. 75%
  5. 95%
  • 25%

  • Q3: Which of the following is most likely to metastasize to the brain?
  1. Breast cancer.
  2. Colorectal carcinoma.
  3. Lung cancer.
  4. Malignant melanoma.
  5. Renal cell carcinoma.
  • Lung cancer
  • Within 2 years, 80% of patients who survive lung cancer will develop brain metastasis.

  • Q4: What are the factors determining prognosis in a patient with cerebral metastases?

It includes:

  • Karnofsky Performance Status (KPS) is the most important factor; breast cancer responds well.
  • Specific primary tumor type and its response to chemotherapy and radiotherapy.
  • State of systemic disease.
  • Length of time since the diagnosis of the primary tumor; a longer duration is associated with a better prognosis.
  • Size and location of brain metastases, with worse outcomes in the posterior fossa.
  • Age: older than 60 years is associated with a worse prognosis compared to younger patients.
  • The number of metastases is also a prognostic factor.
  • Female gender tends to have a better prognosis than males.