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?
- Cerebral metastasis.
- Glioblastoma.
- Hemangioblastoma.
- Medulloblastoma.
- Pilocytic astrocytoma.
- Hemangioblastoma
- Q2: What percentage of cerebral metastases are solitary at the time of presentation?
- 5%
- 25%
- 50%
- 75%
- 95%
- 25%
- Q3: Which of the following is most likely to metastasize to the brain?
- Breast cancer.
- Colorectal carcinoma.
- Lung cancer.
- Malignant melanoma.
- 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.