Case 49: "lost in New Orleans"- temporal mass

posted: January 17, 2000

resident: Greg Dowd and Scott Kutz
attending: Deepak Awasthi

CLINICAL PRESENTATION: This 52 year Czech businessman was found wandering (knocking on doors) the streets of the French Quarter in New Orleans, Louisiana, USA. He was brought to the Medical Center of Louisiana's ER, where he exhibited bizarre behavior and was disoriented (when questioned by a Czech interpretor). The patient was awake and alert. He exhibited no other neurological deficits. His speech was intact, although he was very confused. Patient's general examination revealed no other abnormalities. There were no external signs of trauma. BP: 130/80; pulse: 82; RR: 18; afebrile. An emergent CT scan was obtained. Select views are shown:

A non-contrast CT scan is shown on the left. Note the left temporal mass with hemorrhage (red marker). Due to the suspicion of a tumor a contrasted CT scan was obtained as shown on the right. Note the inhomogenous enhancement (red marker).

What is your differential diagnosis? What management steps would you take?

Please comment: dawast@lsuhsc.edu

STEPS TAKEN AT LSUHSC: The patient was taken to the OR and a left frontotemporal craniotomy was performed. Intraoperative findings revealed a small linear temporal skull fracture; acute subdural hematoma (moderate size) and a sizable left temporal contusion. An anterior temporal lobectomy was performed and the contusion debrided.

Postoperatively the patient was more lucid, he exhibited mild dysphasia.

Comments and Questions about this interesting case are welcomed. Please e-mail: dawast@lsuhsc.edu

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