Multiple cerebral tuberculomas: report of an autopsy case with 37 lesions

An autopsied case of multiple cerebral tuberculomas with 37 lesions, the one with the greatest number of lesions described in the literature, is reported. The patient was a chronic alcoholic and had generalized tuberculosis. The literature on multiple cerebral tuberculomas is reviewed and the neurological clinical picture presented by the patient and the association between generalized tuberculosis and chronic alcoholism are commented upon.     

Atypical cerebral lymphoma with ocular onset: report of a case

A 72 year-old woman is hospitalized and explored in the neurological department because of dementia discovered after a vitrectomy performed to treat a relapsing chronic uveitis. MRI examination shows atypical hyperintense white matter lesions on T2 weighted images related to Lyme disease. Worsening of clinical status, despite appropriate medical treatment and apparition of enhanced nodules MR images rules out the diagnosis of lyme disease and is attributed to brain metastases. The search for primitive tumor is not contributive and a brain biopsy is performed. It discloses a B cells non-hodgkin lymphoma. This case report stresses two points: first, a lymphoma must be one of the diagnosis to evocate if imaging shows an enhancing nodule, or extensive hypersignal of the white matter, second: it emphasizes the value of vitreous analysis searching for lymphoma during chronic uveitis associated to neurological symptoms.     

Miliary tuberculomas of the brain: case report

Tuberculosis (TB) of the central nervous system (CNS) is still prevalent in many developing countries. Tuberculoma is always considered in the differential diagnosis of enhancing intra-axial lesions of the brain. Brain tuberculomas can present in many different clinical and radiological patterns, disseminated or miliary brain tuberculomas are very rare. We describe the case of a 25-year-old immunocompetent female with miliary brain tuberculomas. She presented with a history of progressive headache and unsteady gait. Serial Magnetic resonance imaging (MRI) studies revealed growing, multiple small enhancing lesions in the brain, most lesions measured approximately 2mm in diameter, in both the supratentorial and infratentorial compartments. Her investigation failed to reveal any evidence of TB outside the CNS. Open biopsy revealed multiple caseating granulomas and mycobacterin tuberculosis was cultured. She improved clinically and radiologically after starting anti-tuberculous pharmacotherapy. The clinical course, radiological images and pathological studies of this patient are presented. In conclusion miliary brain tuberculomas are rare and unique clinical and radiological entity. It may affect immunocompetent individuals with no other signs of other systemic involvement.     

Atypical onset of antiphospholipid syndrome in pregnancy: a case report

BACKGROUND: We present a case of an atypical onset of antiphospholipid syndrome (APS). CASE: A woman in her 15th week gestation had a thrombosis of an unknown cerebral cavernoma, which was successfully removed. Twenty-six days after, she was admitted for a severe pain in right hypochondrium and a second class HELLP syndrome was diagnosed. Two days after, she had a fetal loss. After 1 month, laboratory tests revealed high level of antiphospholipid antibodies. At the same time, she developed a spontaneous thrombosis at her right arm. After 6 weeks, antiphospholipid antibodies, tested again, result positive. CONCLUSION: Antiphospholipid antibodies often cause pregnancy complications, but, to our knowledge, this is the first report of an association of antiphospholipid antibodies, with cerebral cavernoma thrombosis and early onset HELLP syndrome.     

Atypical presentations of amyotrophic lateral sclerosis: a case report

Amyotrophic lateral sclerosis (ALS) with atypical symptoms poses a diagnostic challenge to clinicians, frequently resulting in delayed diagnosis. The patient reported here presented with unexplained weight loss and was investigated for 8 months, with an extensive work-up, including several imaging studies, especially to rule out neoplastic processes, before a diagnosis of ALS could be made, largely on the basis of upper and lower motor weakness.     

非典型脉络丛乳头状瘤:一例报告并文献复习

目的报告一例非典型脉络丛乳头状瘤患者临床表现和组织病理学特征,并复习相关文献。方法与结果男性患儿,1岁。主因跌倒后呕吐3d入院,体格检查均未见明显异常。CT显示左侧侧脑室占位性病变,密度略增高,侧脑室扩张、脑积水;相邻区域部分脑组织水肿。术中可见肿瘤组织呈灰白色、质地不均匀,血供丰富,与脑室内脉络丛粘连。光学显微镜观察大部分肿瘤细胞围绕纤维血管呈轴心排列形成乳头状结构,肿瘤细胞无明显异型性;部分区域肿瘤细胞呈实性团块状及小片状生长结构,细胞密度增加,呈轻至中度异型,局灶性坏死;部分肿瘤细胞胞质嗜酸性,可见少量肿瘤巨细胞,偶见核分裂象,计数为2个/10HPF。免疫组织化学染色肿瘤细胞表达广谱细胞角蛋白、突触素、细胞角蛋白8/18、波形蛋白、平足蛋白,灶性表达整合酶作用子1;但不表达S100蛋白、细胞角蛋白19、神经元核抗原、胶质纤维酸性蛋白、上皮膜抗原、嗜铬素A及细胞角蛋白7和20;Ki-67抗原标记指数约为8%。手术后随访6个月,肿瘤无复发。结论非典型脉络丛乳头状瘤为发生于脑室系统、生物学行为介于良性与恶性之间的罕见肿瘤,婴幼儿高发,手术完整切除肿瘤后预后良好,偶有复发。     

Serial MRI findings of intracranial tuberculomas: a case report and review of the literature]

Intracranial tuberculoma is an infectious disorder, occurring with or without tuberculous meningitis. Although intracranial tuberculoma is rare in developed countries, its frequency has increased in recent years in association with aging and immunocompromised hosts. Because of the low sensitivity of Mycobacterium tuberculosis cultures or of DNA detection from cerebrospinal fluid, diagnosis of intracranial tuberculoma is often difficult. Conventional magnetic resonance (MR) imaging of the tuberculoma yields variable results and is indistinct from other inflammatory lesions or brain tumors. We report the case of a 74-year-old woman with progressive neurologic deterioration. MR imaging of the brain showed multiple ring-like enhancing lesions in the supra- and infra-tentorial regions, mimicking multiple metastatic brain tumors. Diffusion-weighted imaging (DWI) of the brain showed homogeneous high signals in each lesion. A cavity in the lung suggested systemic involvement of tuberculosis. Despite extensive examination, tuberculosis could not be detected. Nevertheless, anti-tuberculosis treatment was administered. The patient's neurologic condition initially deteriorated for 4 weeks, then gradually improved. MRI showed marked improvement of the lesions after anti-tuberculosis treatment. Whereas conventional MRI is not specific in such cases, DWI might be useful for early assessment of intracranial tuberculosis.     

Atypical forms of syringomyelia--a case report

The introduction of magnetic resonance imaging (MRI) has made the diagnosis of syringomyelia safer and more exact. Moreover, the lack of correlation between the clinical picture and the MRI findings was demonstrated, and unsuspected cases could be identified as pertaining to syringomyelia. The three cases reported should point at the variable symptomatology in syringomyelia. A more frequent occurrence of unusual symptoms and courses of the disease than previously assumed is discussed.     

Fetal encephalopathy with cerebral calcifications: a case report

The authors report a case of a newborn with severe encephalopathy and cerebral calcifications. The newborn was admitted to Neonatal Intensive Care Unit in Chieti at 2 days of age suffering from continuous generalized seizures. He was the child of healthy first-degree cousins. Cerebral ultrasonography showed bilateral ventricular dilatation and an intrathalamic hyperechoic image. Computed tomography and magnetic resonance imaging showed ventricular and corpus callosus hypoplasia, pachygyria, widespread delayed myelination areas, and basal nuclei and periventricular calcifications. All serum and urine analyses showed normal results. In particular, all demyelinizing metabolic diseases were excluded. Based upon these findings, we speculate that this infant may be suffering from fetal encephalopathy with cerebral calcifications.     

AIDS with acute cerebral infarct: a case report

A 38 year-old male presented with an acute onset of left hemiplegia. Brain magnetic resonance imaging (MRI) revealed a bright lesion by diffusion-weighted imaging with low apparent diffusion coefficient value in the right subcortical region, a finding compatible with an acute cerebral infarct. An old infarct was also noted in the same imaging. Both enzyme-linked immunosorbent assay and Western blot method were positive for human immunodeficiency virus infection. The white blood cell count was 2930 cells / mm3, and the subpopulation study for lymphocyte revealed a decreased cluster of differentiation 4+ count of 149 cells/mm3. Studies for prothrombotic states showed decreased protein S and increased anticardiolipin antibodies. We concluded that this was a case of acquired immunodeficiency syndrome (AIDS) with acute and old cerebral infarcts. This patient might be the first reported case in Taiwan. AIDS might be related with stroke in young patients, a condition probably under-recognized in Taiwan.     

Severe cerebral atrophy in progressive supranuclear palsy: a case report

A 60-year-old woman with a history of hypertension and chronic headache initially presented with irritative personality change and mild but steadily progressive dementia and oral tendency, left-sided hemiplegia, intense nuchal stiffness, and swallowing difficulty in the later stage. She died of bronchopneumonia at the age of 76. The brain showed marked loss of nerve cells with gliosis in the cerebral cortex and fibrillary gliosis in the white matter in addition to the typical pathological findings of progressive supranuclear palsy (PSP): extensive subcortical neurofibrillary tangles (NFTs) and loss of nerve cells with gliosis accentuated in the globus pallidus, Luys body and substantia nigra. In many case reports on PSP, the cerebral cortex is described as normal or within normal limits [Jellinger 1971, Steele et al. 1964], and to our knowledge, there is no reported case of severe cortical atrophy as seen in this case. The differential diagnosis of this case is also discussed.     

Clustering of multifocal cerebral infarctions in CADASIL: a case report

Journal of Neurology -     

MRI of cerebral vein thrombosis in infancy: a case report

We diagnosed primary idiopathic cerebral vein thrombosis in an infant by MRI. The relative noninvasiveness of the scan, ease of imaging in multiple planes, and good image resolution suggest that the scan may be useful in this disorder.     

家族性多发血管网织细胞瘤1例

患者,女性,27岁,因头痛头晕并行走不稳2月入院。查体:神志清,双眼视乳头水肿,左手指鼻试验及轮替动作差,Romberg征阳性,同时双下肢感觉减退。CT示左侧小脑半球一4cm×4cm囊性占位,MRI示小脑囊性占位,强化后发现囊内偏外侧一5mm×5mm结节;同时发现C5~T12脊髓空洞,T10平面脊髓空洞内一瘤结节。于2003年12月3日行小脑肿瘤切除术,术中切除小脑瘤结节后,探查发现延髓背侧表面一瘤结节约3mm大小,呈黄红色桑椹样,一并切出。病理检查证实均为血管网织细胞瘤。两周后再次手术切除脊髓内瘤结节,病理证实为血管网织细胞瘤。术后病人症状消失。追问…     

Multiple sclerosis with higher cerebral dysfunction: a case report

Higher cerebral dysfunctions such as aphasia, apraxia and agnosia have seldom been reported in multiple sclerosis (MS). 12 year-old right-handed boy felt unsteadiness of the body and headache for several days. Two months later, he had the same episode and complained of visual disturbance, and weakness and sensory disturbance on the face and the extremities. Additionally, he showed amnestic aphasia, acalculia, ideomotor apraxia, finger agnosia and right-left disorientation. Cerebrospinal fluid examinations revealed increases IgG, myelin basic protein and neuron specific enolase (11%, 25 ng/ml and 28.8 ng/ml, respectively). X-ray CT scan and MRI-CT examinations revealed sclerotic lesions on the left parietal white matter and the right mid-brain. The diagnosis was made as MS. He was treated with m-PSL (methyl-prednisolone) pulse therapy for three weeks and consecutively treated with PSL for four weeks. He recovered gradually, but visual disturbance and facial palsy remained. After seven months MRI-CT showed a high signal intensity on the left parietal white matter in spite of the disappearance of the lesion on X-ray CT scan. We suggest that these higher cerebral dysfunctions may result from the lesion of the left parietal white matter which produces a disconnection between each cortical area.