gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Article

Send article

A case of isolated angiitis of the central nervous system mimicking a malignant tumor

Meeting Abstract

Search Medline for

  • Jörn Krämer - Neurochirurgische Klinik, Universitätsmedizin Mannheim , Mannheim, Deutschland
  • Felix Sahm - Pathologisches Institut des Universitätsklinikums Heidelberg, Abt. Neuropathologie , Heidelberg, Deutschland
  • Bettina Mührle - Abteilung für Neuroradiologie, Universitätsmedizin Mannheim , Mannheim, Deutschland
  • Brehmer Stefanie - Neurochirurgische Klinik, Universitätsmedizin Mannheim , Mannheim, Deutschland
  • Karen Büsing - Institut für Klinische Radiologie und Nuklearmedizin, Universitätsmedizin Mannheim , Mannheim, Deutschland
  • Daniel Hänggi - Neurochirurgische Klinik, Universitätsmedizin Mannheim , Mannheim, Deutschland
  • Marcel Seiz-Rosenhagen - Neurochirurgische Klinik, Universitätsmedizin Mannheim , Mannheim, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 070

doi: 10.3205/17dgnc633, urn:nbn:de:0183-17dgnc6339

Published: June 9, 2017

© 2017 Krämer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

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.