Teaching NeuroImages: Pseudopathologic brain parenchymal enhancement due to vascular compression in parotid tumor

A 74-year-old man with a history of invasive right parotid gland adenocarcinoma presented with acute onset left hemiparesis. CT angiography showed abnormal cervical and intracranial vascular reflux with enhancement of right middle cerebral artery territory (figure 1). Vascular anomalies were suspected but digital subtraction angiography was normal. There was spontaneous resolution of the symptoms and a follow-up CT showed normalization of the imaging findings (figure 2). Pseudopathological brain parenchymal enhancement has been described rarely, usually as an incidental finding in asymptomatic patients, and mainly related to venous compression, development of collateral vessels, and incompetent venous valves.1,2

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