Vasculitis CNS

Case contributed by A.Prof Frank Gaillard

Presentation

Unfortunately no clinical history is available.

Patient Data

Age: Adult

MRI brain

Modality: MRI

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.

Case Discussion

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. 

Pathology

Final Diagnosis

  1. Dura: No pathologic diagnosis. Crushed (?lymphoid cells)
  2. Brain, leptomeninges and cortex: Chronic leptomeningitis and possible vasculitis.
  3. Brain, superficial and deep white matter: Chronic encephalomyelitis.

Comment: 

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

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Case Information

rID: 5131
Case created: 8th Dec 2008
Last edited: 22nd Feb 2016
Inclusion in quiz mode: Included

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