Fluctuating Neurologic Symptoms in a Patient With Brain Lesion

Abstract

There is a broad spectrum of focal brain lesion in humans. They include primary brain tumor, non-neoplastic cysts, metastatic lesion, stroke, vascular malformations, aneurysm, inflammatory lesions and multiple sclerosis. The case was a 45-year-old female with fluctuating visual problem, ataxia, right upper limbs weakness, and transient amnesia who was referred to the neurologist. She was alert and under treatment from 10 years before by anti-convulsive drug for seizure with unknown etiology. Physical examination revealed ataxic gate, left-sided homonymous lower quadrantanopia and loss of venous pulse in ophthalmoscopy; there were no other pathological findings. Primary brain imaging (axial brain CT scan) was performed which showed a suspected lesion in right-sided parietooccipital area. Brain MRI and CT angiography revealed a heterogeneous lesion in right-sided parietooccipital area without edema and a mass in the form of vascular malformation. Because of the size and location of the lesion, it seemed inoperable. Treatment plan included serial visit and imaging to follow the progress of lesion and probable complications such as intralesional hemorrhage and hydrocephalia. J Med Cases. 2017;8(2):67-69 doi: https://doi.org/10.14740/jmc2706w