Weekly Image Challenge – July 23, 2023

This 27-year-old lady presented with a short history of generalized tonic-clonic seizures for 2 days, and an altered level of consciousness for 1 day. What is the most likely diagnosis?

  1. Low-grade glioma
  2. Parafalcine meningioma
  3. High-grade glioma
  4. Lymphoma
  5. Cerebral abscess


Congratulations to those who selected high-grade glioma (Astrocytoma IV). The heterogeneous contrast enhancement, infiltrating nature, surrounding edema & extension to the contralateral side are important distinguishing features. The falx is involved which is unusual for a glioma.

Infiltrating high-grade meningioma was a close differential because of the location and falx involvement. However, heterogenous contrast enhancement and the absence of a dural tail were pointing against it.