ARJ
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9) A 65-year-old man comes to medical attention because of multiple neurologic deficits, including loss of sensation in his right hand, weakness of the left lower leg, and a visual field deficit. He has smoked two packs of cigarettes daily for 40 years. His medical history is remarkable for asthma and emphysema. Examination of the fundus is unremarkable. His temperature is 37 C (98.6 F), blood pressure is 137/86 mm Hg, pulse is 86/min, and respirations are 24/min. MRI of the head reveals five different intracerebral lesions, ranging from 1 to 3 cm in main diameter and located at the gray-white matter junction in both cerebral hemispheres. The lesions are sharply demarcated, and contrast enhancement after gadolinium administration is present in all of them. Which of the following is the most likely diagnosis?
A. Abscesses
B. Arteriovenous malformations
C. Embolic infarcts
D. Metastases
E. Multifocal glioblastoma multiforme
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| lucky
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D.
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| GoStep2
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D). Metastases
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| phuluong2k
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D
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| ARJ
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Thats was easy one
The correct answer is
D. Awareness of the typical MRI/CT appearance of brain metastases is important because often patients present with cerebral metastases without prior history of cancer disease. Thus, a radiologic diagnosis of brain metastatic disease may prompt a search for the underlying primary tumor, which is often a lung carcinoma in men and lung or breast carcinoma in woman. Melanomas also have a peculiar propensity to metastasize to the brain. The typical radiologic features of brain metastases are summarized in this case: multiplicity of lesions, well-circumscribed borders, and location at the gray-white matter junction.
Multiple abscesses (choice A) may develop in patients with sepsis and, particularly, in association with conditions leading to septic emboli (e.g., infective endocarditis).
Arteriovenous malformations (AVMs) (choice B) are abnormal conglomerates of disorganized blood vessels composed of arteries, veins, and intermediate vessels with discontinuous elastic lamina. Intracerebral hemorrhage is their most frequent mode of clinical presentation.
Embolic infarcts (choice C) would be associated with wedge-shaped cortical lesions. Frequently, embolic infarcts are hemorrhagic.
Multifocal glioblastoma multiforme (GBM) (choice E), the most frequent malignant primary brain neoplasm, manifests as an ill-defined mass in the white matter. Contrast enhancement is usually present. Multifocal GBM is a rare event. Even so, the lesions are poorly circumscribed and centered in the white matter.
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