A 71-year-old man with history of adenocarcinoma presented to the hospital with altered mental status that had worsened over a time period of 3 weeks
A 71-year-old male patient reported with worrying altered mental status to the hospital. According to the patient, his condition had progressed over the preceding 3 weeks. Similarly, one month before presenting to the hospital, he visited his primary care physician with complaint of anaemia and abdominal pain.
A colonoscopy was performed which showed an obstructing, circumferential mass in the right colon. Biopsy findings of the mass were consistent with the diagnosis of adenocarcinoma. CT scan of the pelvis, abdomen and chest showed widespread metastases. In addition to the mass in the right colon, multiple skeletal lesions and a lesion in the lower lobe of the right lung was also present.
The colonic mass was surgically resected. Histopathology of the mass confirmed the diagnosis of adenocarcinoma.
Given the recent change in the mental status of the patient, gadolinium-enhanced magnetic resonance imaging of the head was performed
The MRI revealed numerous lesions without mass effect or oedema, however, with ring enhancement. The most likely explanation of the lesions was cerebral metastases. However, differential diagnosis of the brain lesion also included tuberculosis, neurocysticercosis and bacterial abscesses. Blood cultures and evaluations were negative for tuberculosis and human immunodeficiency virus, ruling out the differential diagnoses.
A lumbar puncture was performed and the cerebrospinal fluid was sent for cytologic analysis which showed clusters of adenocarcinoma cells.
The patient died a week after his family pursued palliative care.
Budhram, A., & Shettar, B. (2020). Cerebral Metastases. The New England Journal of Medicine, 382(17), e36-e36.