A 74-year old woman with gradual visual disturbance and apathy

Περίληψη

A 74-year-old woman was admitted for evaluation of one year history of vision disturbance. Her
husband also reported gait disturbance and personality changes with deteriorating social interactions
and difficulties performing activities of daily living. Her past medical history was otherwise unremarkable.
Neurological examination revealed disorientation in time and place, associated with apathy (Glasgow
Coma Scale: 14, 6-5-4) central left facial palsy and bilateral positive primitive reflexes (grasp and
palmomental). Visual fields could not be evaluated due to poor collaboration with the patient.
Fundoscopy showed bilateral optic disc edema. The rest neurological examination was normal.
Hematological and biochemical tests were normal except for subtle hypothyroidism. A brain MRI(Figure)
demonstrated a right frontal well circumscribed lesion with peripheral enhancement and displacement
of midline brain structures. Neurosurgical consultation was followed by surgical removal of the lesion
and histopathology.