Artikel
A case of isolated angiitis of the central nervous system mimicking a malignant tumor
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Veröffentlicht: | 9. Juni 2017 |
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Objective: Isolated angiitis of the brain is a severe but rare disease. MRI, angiography and biopsy are are often required for the diagnosis. There are reports about cerebral vasculitis lesions mimicking malignant brain tumors.
Methods: We describe a case of a 61 year old patient that presented with speech arrest and focal epileptic seizures. MRI scan showed a contrast enhancing lesion in the left frontal lobe with perifocal edema. 1[F]-FET-PET detected an increased tracer uptake (with a tumor/brain ratio of 2,8) suspicious for a high grade glioma. Surgery was planned and, due to the eloquent location of the tumor, performed as an awake craniotomy. The lesion, showing clear 5-ALA induced fluorescence, was resected completely.
Results: Histopathological examination confirmed the diagnosis of a lymphocytic vasculitis with transmural infiltration and necrosis. After recovering from a reversible aphasia and SMA-triggered hemiparesis within the first postoperative week, the patient underwent further medical therapy after complete wound healing
Conclusion: The radiologic diagnosis of an isolated angiitis of the central nervous system presents a challenge. Even with the adjunct of 18-[F]-FET-PET to standard preoperative MRI the lesion was interpreted as a malignant tumour. This case report underlines that inflammatory lesions like vasculitis might mimick malignant brain tumors. Histological diagnosis is crucial to lead the patient to adequate therapy.