An 86-year-old, right-handed woman was hospitalized because of 1 month of difficulties in naming familiar objects and people. The patient presented circumlocution, mentioning the function and the use of the objects. On neurological assessment, the spontaneous speech was fluent, and auditory comprehension and repetitions were intact. Neither motor symptoms nor sensory deficits were detected. The patient could read and write normally. She had no difficulty with a test that required her to perform a sequential set of hand movements. Also, the patient did not have any discomfort about neurological symptoms, memory loss, bizarre behaviors, or delirium symptoms, except anomic aphasia. A laboratory work-up including complete blood cell counts; electrolyte levels; renal, liver, and thyroid function profiles; vitamin B12 and folic acid; serology for syphilis; and human immunodeficiency virus produced normal results. A bran CT and contrast-enhanced MRI revealed a huge solid tumor over the left temporal lobe, causing apparent perifocal edema, compressing the left lateral ventricle, and pushing the midline to the right (Figure 1). She underwent standard tumor resection and radiotherapy. The pathological result revealed a glioblastoma multiforme. However, the anomic aphasia did not improve postoperatively.
FIGURE 1.Axial CT [A] and Axial T2-Weighed MR [B] Images Show a Huge and Heterogeneous Tumor (4.2×4.3×5.6 cm) Over the Left Temporal Lobe, With a Nonspecific “Dural Tail” Sign (white arrows). Coronal T1-Weighted MR images [C] With Injection of Gadolinium Revealed a Central Necrosis and a Nonspecific “Dural Tail” Sign of the Tumor (white arrows).