Makindo Medical Notes

🩺 Clinical Course

Day 1: Admitted with sudden right-sided weakness and expressive dysphasia. CT suggested an ischaemic stroke in the left frontal lobe, but findings were atypical (no vascular territory pattern).

Day 15: The patient initially improved but then developed progressive weakness. Repeat MRI revealed lesion enlargement with increasing oedema.

Day 18: New focal seizures and headache. MRI showed mass effect with poorly defined margins, raising suspicion of neoplasm.

Day 21: Marked neurological deterioration. Contrast-enhanced MRI demonstrated irregular ring enhancement and necrotic centre, confirming a high-grade glioma (likely Glioblastoma multiforme).

Teaching Point: Astrocytomas evolve over days to weeks with increasing enhancement, while infarcts typically resolve or become sharply demarcated. Always consider tumour when a “stroke” worsens subacutely without vascular explanation.

💡 Key Learning: A “stroke mimic” pattern with progression, mass effect, and new contrast enhancement should prompt urgent neuro-oncology referral.

• High-grade astrocytoma (Glioblastoma multiforme): Crosses corpus callosum (“butterfly” pattern), heterogeneous enhancement, necrosis, oedema.
• Primary CNS lymphoma: Homogeneous enhancement; strongly contrast avid; often in immunocompromised (HIV-positive) patients.
• Cerebral toxoplasmosis: Multiple ring-enhancing lesions with predilection for basal ganglia; improves with anti-toxoplasma therapy.

Tip: Glioblastomas show irregular, thick ring enhancement with central necrosis; lymphoma typically enhances uniformly without necrosis.