Confusion, ataxia There is a globular and elliptical shaped enhancing mass starting from the right basal ganglia extended superiorly toward right caudate head and downward to the level of right midbrain with the extensive surrounding edema. The longitudinal diameter of the mass is measured about 43.7 mm in transverse diameter was measured around 23 mm. There is also midline shift toward left side at the level of the third ventricle measured around 6 mm.Due to significant motion artifact during susceptibility imaging, intralesional hemorrhagic foci cannot be evaluated precisely.There is no evidence of restricted diffusion on the scan.There is no evidence of additional enhancing lesion on the scan.The differential diagnosis of this intra-axial mass includes primary brain tumor such as high-grade glioma or metastatic lesion.Underlying brain shows multiple encephalomalacia seen including right external capsule left cerebellar hemisphere and right posterior edema of internal capsule indicate chronic ischemic infarct related encephalomalacia seen.Moderate degree nonspecific small vessel ischemic disease is also seen.The ventricles, sulci and cisterns are symmetric and unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.
1. Intra-axial mass centered at the level of right basal ganglia extends from right caudate nucleus to the level of right midbrain with contrast enhancement, surrounding edema and mass effect as described above. Differential diagnosis includes primary malignant brain tumor or metastasis2. Underlying brain shows multifocal chronic ischemic infarcts with encephalomalacia seen as well as moderate degree nonspecific small vessel ischemic disease.3. There is no evidence of acute ischemic lesion on the scan.