Presenter

Raymond Wong

Bio

Raymond Wong is a PGY1 Neuropathology resident at the University of Toronto. He completed his PhD at the University of Toronto focused on neuro-oncology and hypoxic-ischemic brain injury.

Authors

Raymond Wong1, Adrian Levine1,2, Cynthia Hawkins1,2

  1. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
  2. SickKids Hospital, Toronto, ON, Canada

Conflict of Interest

I do not have a relationship with a for-profit and/or a not-for-profit organization to disclose.

Clinical Summary

12-year-old boy, previously healthy, presented to the emergency department with a 1-day history of progressive headache, vomiting, and one episode of syncope.

CT head showed a large acute right parietotemporal intraparenchymal hematoma with perilesional and diffuse cerebral edema causing significant mass effect including 9 mm leftward midline shift, right uncal medialization and ventricular compression. There was no evidence of an underlying arteriovenous malformation or aneurysm within the limitations of CTA/CTV. Additionally, no acute fracture, lytic lesion or periosteal reaction.

The patient received urgent right decompressive hemicraniectomy and biopsy.

Discussion points

  1. What is the differential diagnosis and immunohistochemical workup?
  2. What molecular testing would be useful?
  3. What is the clinical and prognostic significance of this diagnosis?

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