Brain Tumor Res Treat.  2017 Apr;5(1):30-33. 10.14791/btrt.2017.5.1.30.

Primary Central Nervous System Vasculitis Mimicking a Cortical Brain Tumor: A Case Report

Affiliations
  • 1Department of Neurosurgery, Kwangju Christian Hospital, Gwangju, Korea.
  • 2Department of Neurosurgery, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Korea. jung-ty@chonnam.ac.kr
  • 3Department of Pathology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Korea.
  • 4Department of Radiology, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, Hwasun, Korea.

Abstract

We report a case of primary central nervous system vasculitis (PCNSV) mimicking a cortical brain tumor. A 25-year-old woman presented with a 2-week history of headache and transient right hemiparesis. Brain magnetic resonance imaging (MRI) revealed a cortical-involving lesion on the left frontal lobe. The 6-cm sized lesion showed low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. The lesion had continual linear enhancement on the subcortical white matter and leptomeninges. There was no evidence of hemorrhage on susceptibility-weighted images and no diffusion restriction on diffusion-weighted images. The regional cerebral blood volume was decreased on the MR perfusion images, and spectroscopy showed increased lactate and lipid peaks. The symptoms were aggravated by fever and seizures. Biopsy was performed to rule out tumorous or inflammatory lesions. Pathologically, lymphocytes were infiltrated on the vessels, and the arachnoid membrane was thickened with inflammatory cells. The patient did not have any underlying diseases, including immune disorders. After high-dose steroid administration, her symptoms improved. Two months later, brain MRI showed a reduction in the infiltration of the T2 hyperintensity lesion with subtle subcortical enhancement. We present a case of PCNSV involving the left frontal lobe, showing vasogenic edema, mass effect, and subcortical linear contrast enhancement without hemorrhage or infarction.

Keyword

Central nervous system; Vasculitis; Radiology; Steroids

MeSH Terms

Adult
Arachnoid
Biopsy
Blood Volume
Brain Neoplasms*
Brain*
Central Nervous System
Diffusion
Edema
Female
Fever
Frontal Lobe
Headache
Hemorrhage
Humans
Immune System Diseases
Infarction
Lactic Acid
Lymphocytes
Magnetic Resonance Imaging
Membranes
Paresis
Perfusion
Seizures
Spectrum Analysis
Steroids
Vasculitis
Vasculitis, Central Nervous System*
White Matter
Lactic Acid
Steroids

Figure

  • Fig. 1 MR radiologic findings of primary central nervous system vasculitis. A and B: The left frontal lesion showed low signal intensity on T1-weighted MR images and high signal intensity on T2-weighted images. C: There was no hemorrhage on susceptibility-weighted images. D: The subcortical area of the lesion showed high signal intensity on an ADC map. E and F: The subcortical area and leptomeninges had linear and punctate enhancement. G and H: The regional cerebral blood volume of the lesion was decreased on MR perfusion images, and the lactate peak was increased on MR spectroscopy. ADC, apparent diffusion coefficient.

  • Fig. 2 Operative and pathologic findings of primary central nervous system vasculitis. A: The arachnoid membrane was focally thickened with yellowish discoloration, while the cortex showed a normal appearance. B: Vasculocentric lymphocytic infiltration (hematoxylin and eosin staining; original magnification, ×100). C: Immunopositivity for CD3 (original magnification, ×200). D: Immunopositivity for CD79a (original magnification, ×200).

  • Fig. 3 MR radiologic findings of improved primary central nervous system vasculitis. Two months later, follow-up brain MRI showed a reduction in the infiltration of the T2 hyperintensity lesion (A) without subcortical enhancement in the left frontal lobe (B).


Cited by  2 articles

A Case of Primary Central Nervous System Vasculitis That Worsened Despite Early Corticosteroid Therapy
Sang-Youl Yoon, Ki-Su Park, Seong-Hyun Park, Ji-Young Park
Brain Tumor Res Treat. 2019;7(2):164-167.    doi: 10.14791/btrt.2019.7.e37.

A Case of Primary Central Nervous System Vasculitis That Worsened Despite Early Corticosteroid Therapy
Sang-Youl Yoon, Ki-Su Park, Seong-Hyun Park, Ji-Young Park
Brain Tumor Res Treat. 2019;7(2):164-167.    doi: 10.14791/btrt.2019.7.e37.


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