Unfortunately no clinical history is available.
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MRI of the brain demonstrates extensive patchy T2 bright white matter change, with involvement also of the posterior limb of the internal capsule. No enhancement.
Unfortunately I have lost the clinical details of this patient, and all I have available is the results of a dural and brain biopsy, which is non-specific, suggests possible vasculitis, and importantly does not demonstrate any evidence of demyelination, which on imaging would certainly be a possibility.
- Dura: No pathologic diagnosis. Crushed (?lymphoid cells)
- Brain, leptomeninges and cortex: Chronic leptomeningitis and possible vasculitis.
- Brain, superficial and deep white matter: Chronic encephalomyelitis.
These biopsies are indicative of the inflammatory process, of chronic duration, that is not associated with an identifiable microbiologic agent such as acid-fast bacilli, fungi, or toxoplasmosis. The pattern of the inflammatory infiltrate that focally involves vessel walls may be a part of the spectrum of a vasculitic process, either primary or secondary. There was no evidence of a demyelinating disease process. Please correlate these findings with the results of microbiologic studies