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A man in his late 20s with a 2-month history of stage IV germ-cell testicular tumour and multiple lung and liver metastases, previously treated with chemotherapy, was admitted with a depressed level of consciousness.
CT head scan showed marked cerebral oedema with bilateral sulcal and cisternal effacement. Postcontrast scans showed a high attenuation, enhancing lesion in the right parieto-occipital lobe compatible with a metastasis. MRI scan showed extensive and multiple areas of high signal intensity on axial and coronal T2 and fluid-attenuated inversion recovery sequences. These involved the white matter of the cerebral and cerebellar hemispheres and brainstem. Gradient echo …