Young woman harbouring a midline space occupying brain lesion

Abstract

Young Pakistani woman harbouring a midline space occupying lesion with conglomerate enhancement pattern.

A30-year-old Pakistani woman presented with a one-month history of progressive left upper extremity weakness and headache. The patient was afebrile andphysical examination, during which the patient was awake, alert and fully oriented, revealed minor facial paresis on the left, pupils normal in size with no deviation at primary gaze and normal oculomotor function bilaterally. The soft palate was symmetrically elevated, and the tongue mobile with a full range of motion. Left arm (brachial) paresis with pronation and disordered fine motor skills were observed.The patient was able to walk safely, with a steady gait and normal posture. Tendon reflexes weresymmetrically increased at the upper extremities and normal at the lower extremities, with a negative Babinski reflex. Hypoesthesia and hypoalgesia were also noted on the left. All CBC (complete blood count) values were normal, and a brain MRI scan was performed (Fig 1); a large, lobulated, contrast-enhanced lesion was depicted at the region of the thalamus and basal ganglia on the right, surrounded by vasogenic oedema crossing the midline and extended at the left thalamus (fig. 1 a-d). Chest and Abdomen CT-scans were normal.