Butterfly Appearance in Corpus Callosum

50-year-old female with progressive headaches and personality changes over 3 months. MRI shows a butterfly-shaped lesion crossing the corpus callosum.

Clinical Presentation

A 50-year-old female presents with progressive headaches, memory difficulties, and personality changes over the past 3 months. No significant past medical history.

MRI brain reveals a large infiltrative mass centered in the corpus callosum with a classic 'butterfly' appearance extending into both cerebral hemispheres.

The lesion demonstrates peripheral enhancement with central necrosis on post-contrast T1-weighted images. There is significant surrounding vasogenic edema.

Diffusion-weighted imaging shows restricted diffusion in the solid components, suggesting high cellularity.

MR spectroscopy demonstrates elevated choline, reduced NAA, and a lactate peak, consistent with high-grade glioma.

Biopsy confirmed glioblastoma, IDH-wildtype, WHO grade 4.

Key Imaging Findings

• Butterfly-shaped lesion crossing corpus callosum
• Peripheral enhancement with central necrosis
• Surrounding vasogenic edema
• Restricted diffusion in solid components
• Elevated choline/NAA ratio on MRS

Discussion

Butterfly glioblastoma is a highly aggressive variant of glioblastoma that crosses the corpus callosum. Prognosis is poor with median survival of 6-9 months. Treatment typically involves maximal safe resection followed by chemoradiation.