An Unusual Presentation of Ischemic Stroke as Brain Mass lesion

Abstract

BackgroundIschemic stroke is one of the common neurological disorders; however, its presentation as a brain mass lesion is rare.Case Presentation45 year gentleman of Afro‐American origin presented with complaints of right sided weakness, progressing over at least 3 weeks prior to admission. He was found to have no risk factors for stroke except history of substance abuse. He had right sided weakness involving face, and upper limbs more than lower limbs on exam. MRI with gadolinium of the brain revealed a moderately large left fronto‐parietal lesion that showed cortical enhancement. The primary differential was a neoplastic lesion. The patient's clinical condition was progressively worsening, and a brain biopsy was performed. He was simultaneously investigated for primary malignancy elsewhere in the body but had a negative workup. Brain biopsy was reported as ischemic tissue necrosis with no evidence of neoplasm/vasculitis. His course was complicated by development of subdural hematoma after initiation of oral anti‐coagulation for his ischemic stroke. He responded well to surgical evacuation of the hematoma.ConclusionThis rare presentation of a stroke as brain mass lesion signifies the importance of being vigilant about such a possibility. This case is reported for the rarity of its presentation and its impact on the diagnostic and therapeutic management strategies.