Clinical Summary

A 76-year-old male with a history of cognitive decline and coordination difficulties lasting 3-4 months presented to the hospital. Complaints of walking and bumping into objects were reported along a similar duration, likely due to left sided homonymous hemianopsia. Past medical history includes multiple system issues, including heart failure with reduced ejection fraction secondary to ischemic cardiomyopathy with CRT-D (Cardiac resynchronization therapy defibrillator) in place, hypertension, complicated left ventricular thrombus requiring lifelong apixab, pulmonary fibrosis, emphysema, T2DM with nephropathy and neuropathy. No known family history was reported. Patient also has a history of smoking, 100 packs-year as well as a past bladder carcinoma resected in 2022, with recurrence in 2015. MRI was ruled out by non-compatible device. CT scan revealed a new, right parieto-occipital solid-cystic lesion with a small (5 mm) contrast-enhancing nodule. There was associated intracranial mass effects with sulcal effacement, compression of the right lateral ventricle and millimetric leftward midline shift. Slight growth of a parafalcine extraaxial previously detected mass was identified.  The right parietal lesion was resected.

Discussion points

1. Imaging differential diagnosis

2. Histopathological diagnosis

3. Pathogenesis