Encephalomalacia Simulating the Clinical and Radiological Aspects of Brain Tumor

A Report of 6 Cases

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And when the time comes to make public one's score, it is done somewhat apologetically, but with the expectation that others may profit by it and with the assurance they will come to improve upon it.—Harvey Cushing2

The differential diagnosis between cerebral vascular disease and a space-occupying lesion is a challenge, even to the experienced neurologist. The occurrence of symptoms suggesting an acute cerebrovascular disorder in patients harboring brain tumors is perhaps the greatest source of error.6 Apoplectiform symptoms, such as occur in cases of glioblastoma multiforme, with its tendency towards intravascular thrombosis and

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    Case 1. Pneumoencephalogram showing dilatation and displacement of ventricular system towards the left, caused by an area of infarction in the right parietal lobe.

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    Case 3. Displacement of pineal gland to the right by an infarction in the left hemisphere.

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    Case 3. (A) Pneumoencephalogram showing massive shift of ventricular system in anteroposterior view and (B) distortion of left lateral ventricle in lateral view. Encephalomalacia, left hemisphere, simulating left frontoparietal tumor.

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    Case 4. Ventriculogram showing displacement and distortion of ventricular system caused by a large area of infarction in right frontotemporal region.

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    Case 5. Left carotid angiogram showing displacement of anterior cerebral artery across the midline in anteroposterior view and marked elevation of the Sylvian group in lateral view, caused by softening of temporal lobe, basal ganglia and thalamus, simulating tumor of temporal lobe.

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    Case 6. Massive infarction of right cerebral hemisphere with edema (below), causing shift of the pineal gland (above, right), and displacement of the ventricular system (above, left), simulating a tumor in right temporoparietal region.

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