UNUSUAL EVOLUTION AND COMPUTERIZED TOMOGRAPHIC APPEARANCE OF A GLIOSARCOMA

A patient with a remote infarct, seizures, mild hemiparesis, and dysph asia became obtunded over four months and died. Computerized tomograph y (CT) over 5 years showed a consistent, large, wedge-shaped left hemi sphere hypodensity with a central calcification, but without signs of mass effect. This was interpreted as an infarct of the left middle cer ebral artery territory. Post-mortem examination of the brain revealed the entire area appearing as infarct on CT was a gliosarcoma. We suspe ct that the unusual CT appearance of the lesion was likely caused by m ultiple pathologies: a low grade glioma transforming into a gliosarcom a that was able to spread throughout the area of infarct encephalomala cia without revealing a typical CT appearance of mass effect. The pati ent's brief period of deterioration probably coincided with transforma tion of the tumor into a gliosarcoma. The variable CT characteristics of gliosarcomas are reviewed.