Patient, male, 43, right upper limb activity is not good for more than January, accompanied by walkway instability for 7 days

Neurosurgery"Basic Information"patients, male, 43-year-old"Main Complaint"the right upper limb activity is not good in January, accompanied by walkway instability 7 days
"current medical history"patients due to no obvious cause of right upper limb activity less than 1 month before admission, showing that the right hand fine activity is not good, with pain in the upper right limbIn the first 10 days before admission without obvious causes of speech confusion, no physical activity, no dizziness, nausea, vomitingThe patient's disease in the course of neglect of the double shadow, no difficulty swallowing, drinking coughthethethethe microcephalythe circular low density shadow, the T1WI on the MRI is a low signal, t2WI is equal and high signal, FLAIR is slightly higher and slightly lower signal, the DWI is a low signal, the ADC is a high signal, the enhanced scanning ring-like reinforcement size is about 2.4x2The of Pathology Diagnosis
glioblastoma "This case analysis" this case of middle-aged male, right cerebellum hemispheric occupancy lesions, lesions most of the cystic, enhanced scanning visible wall strengthening, no obvious wall nodules and empty blood vessel shadow, need to take into account the high-level glioma with cystic change, metastatic tumor with cystic change, patients do not have a history of primary tumor, so first consider high-level glioma Case summary: the incidence of glioblastoma is more age, foreign studies show that 65-75 years old is a peak, adults good hair in the frontal lobe, children good hair in the brain stem, mostly single-shot, occasionally more frequent In 2007, the WHO central nervous system tumor pathological classification belongs to the IV-grade astrocyma, accompanied by a differentiated glioma component called secondary glioblastoma, not accompanied by a differentiated colloma component is called primary glioblastoma The clinical manifestations of glioblastoma are related to the growth of tumor sites, the structure of aggression and its occupancy effect, and are characterized by headache, dizziness, mental nerve and other symptoms The cytological characteristics of glioblastoma are obvious necrosis lesions in tumor tissue, the surrounding tumor cells are fenced, and the small blood vessels within the interstitial mass are significantly increasing in buds, glomerular shapes, or form curved long band shape; Tumor cells are often polymorphic and common to polynuclear macrocells, so they are often referred to as polymorphic glioblastoma Due to the high interstitar and immaturity of tumor cells, the new vascular structure is poor, easy to thrombosis, causing the tumor center part of the blood supply interruption and necrosis cystic change or blood vessel rupture bleeding Therefore, the tumor has the characteristics of multi-form image performance Watanabe, etc., is thought to be glioblastoma, where T2WI is typically characterized by a central high-signal core (as opposed to cystic necrosis), surrounded by first-class signal edges (equivalent to living tumor tissue), and a peripheral high signal of the finger (as opposed to edema brain tissue with isolated tumor cells) Other manifestations are: (1) MR is shown as a short T1, short T2 signal, indicating bleeding (2) Because the tumor is inlative growth, the boundary is not clear (3) The tumor malignant degree is high, the growth is rapid, when found that the lesions are generally larger, so its occupancy signs are obvious, as the side of the ventricle is stressed, smaller, or even disappeared It can also invade the lateral ventricle and form a lump in the lateral brain (4) The lesions around the long T1 long T2 signal edema belt, to the white matter area of the brain is obvious, more finger-like or flame-like (5) Tumors often affect two brain leaves or adjacent structures, more invasion and the body, the base section and the meninges, lesions across the body growth, when the tumor cross-body growth to the opposite hemisphere of the brain, the "butterfly" or "coral" sign This case is middle-aged people, occurred in the right cerebellum hemisphere, lesions to the obvious cystic change-based, bleeding is rare, wall ring-like strengthening, rare need to identify with the following diseases: 1, single metastatic tumor, with glioblastoma, the same disease progress faster, enhanced also visible ring-like reinforcement, but most metastatic tumor boundaries are generally clear T2WI/FLAIR and T1WI-enhanced before-and-after control tumors "false shrinkage" and "tumor ex-immersion" help identify the two The history of primary tumors is more helpful in their identification 2, primary central nervous system lymphoma T2WI on the present of such signals or low signals for its more characteristic performance The edema around the lesions is lighter, the accounting effect is lighter, the lesions signal is more uniform, and the necrosis sacs in the tumor become rare After enhancement, it is more likely to be lumped or leaf-like The form of glioblastoma is irregular, the signal is not uniform, the cystic necrosis is common, the tumor can be seen bleeding, edema and occupancy signs are obvious 3, hemangioblastoma, the common type is large cystic wall nodule, nodules are significantly strengthened, the sac wall is not strengthened; source: the image
park