The patient went on to have a biopsy due to mass effect and concern for an underlying mass.
Histology
MICROSCOPIC DESCRIPTION:
The sections include cerebral cortex and white matter. There are areas of haemorrhage and necrosis in the cortex, associated with sheets of foamy macrophages. Scattered necrotic neurons are present. They have shrunken nuclei with loss of nuclear staining. There is perivascular inflammation. The infiltrate comprises mixed small mature lymphocytes, plasma cells and larger reactive lymphocytes. The neuropil is focally oedematous and contains some neutrophils in the areas of haemorrhage. No granulomas are seen. No viral inclusions are identified. There is no evidence of malignancy. The lymphoid cells show no nuclear atypia. There is normal distribution of B and T-lymphocytes. Some amyloid plaques are seen in the cortex. The blood vessels show no amyloid.
FINAL DIAGNOSIS:
Organising infarct. No tumour identified.