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2445 Surgery

A 63-year-old woman presents with a several-week history of headaches and difficulties with speech. A sister who lives with her claims that her language “has recently not been making much sense” and that she is a bit confused. Her condition seems to be deteriorating. On neurologic examination, she has a moderately severe aphasia, with difficulty understanding language and following commands, and she makes frequent paraphasic errors when she speaks. There are no other motor or sensory deficits. An MRI with intravenous contrast reveals the presence of a ring-enhancing mass lesion within the substance of the left temporal lobe. The lesion is approximately 3 cm in great-est diameter, poorly demarcated from the surrounding brain, and surrounded by a moderate amount of cerebral edema. Findings on routine admission tests, including a chest x-ray and serum chemistry, are unremarkable. What is the most likely diagnosis?

ALow-grade cerebral astrocytoma
BGlioblastoma multiforme
CMetastasis to the brain from an occult primary cancer
DMeningioma
Surgery
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