Middle-aged male, sudden coma for 10 hours, please diagnose!

Department of Neurosurgery , Basic Information , Patient, male, 44-year-old , 44-year-old , sudden coma for 10 hoursComment: Left temporal lobe length T1 long T2 abnormal signal shadow, morphological rules, class circle, uneven signal, within it see multiple line-like separation, around no obvious edemaDWI lesions are equal signals, local low signal area, enhanced scanning visible separation line-like reinforcement, residual lesions area basically no strengtheningMrA Brain Blood vessels did not see abnormal changesConsider low-grade astrocytomasPathological diagnosis: Less protrusion glioma (WHOII grade) (case summary) In the classification method issued by WHO in 2007, the tumor of the origin of the less protrusion glioblastic cell belongs to the neuroepial tumor, divided into the less protruosine glioma (oligodroglioma, grade II) and mesostatic less protruoglioma (anaplasticoligo-dendrogo, grade III)Tumors of the origin of less protrusion cells account for 33% of adult gliomas, and are the second largest adult glioma after polymorphic glioblastomaCompared with the same level of astrocyteoma, the clinical process of less protrusion glioma is longer, and the prognosis is betterLess protrusion glioblastoma is better at the frontal lobeThe lesions, which affect the cortex, may be the main cause of epilepsyLess protrusion glioma usually does not cause midline structural shift is also one of its characteristics, even if the tumor is located next to the middle line, but also rarely causes or only causes mild midline structural shiftTumor peripheral edema is considered to be an important indicator of high-level tumorsHowever, less protrusion glioblastoma is rarely accompanied by tumor-circumsal vascular edemaThis is another characteristic manifestation of less protrusion gliomaThe size difference of less protrusion glioma was large, and the tumor of grade III-IV was significantly larger than that of grade II tumorLess protrusion glioma MR signal is more uneven, prone to tumor cystic and calcification Enhanced scanning, the reinforcement mode is more uneven, can be fully strengthened or partially reinforced, some tumors are visible nodule-like reinforcement Less protrusion glioma should be identified with astrocyts, although the two are the same glioma, the image show many similarities, but there are differences between the two (1) less protrusion glioblastoma occurs more in the superficial part of the brain, while astrocytomoma occurs more in the deep part of the brain; (2) less protrusion glioblastoma around more or only mild edema, and star cell tumors are more of different degrees of tumor peripheral edema, and moderate edema more common; (3) Less protrusion glioblastoma usually does not cause midline structural shift or only mild midline structural shift; (4) less protrusion glioma calcification rate is significantly higher than astrocyt tumor; (5) less protrusion glioma is more or only mildly strengthened, while astrocytomas, especially high-level astrocytes, are more than moderate to the medium-degree strengthening of the tumor Source: Image Park