Spontaneously Changing Mri Findings Of Primary Central Nervous System Vasculitis: A Case Report
Takatsu, H., Komatsu, T., Fukasawa, N., Fukuda, T., & Iguchi, Y. (2021). Spontaneously changing MRI findings of primary central nervous system vasculitis: A case report. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 83, 125–127. https://doi.org/10.1016/j.jocn.2020.11.012
View Original Source →Abstract
Spontaneously disappearing lesions on magnetic resonance imaging (MRI) has been described in primary central nervous system lymphoma. In this case, we report our experience of spontaneously changing MRI findings of primary central nervous system vasculitis (PCNSV) confirmed histopathologically. A 69-year-old man presented with sudden unsteady gait. Fluid-attenuated inversion recovery (FLAIR) images showed high-intensity areas in the right deep white matter. Contrast-enhanced T1-weighted MRI demonstrated a nodular lesion in the white matter of the left occipitoparietal lobe. On repeat MRI 7 days later, FLAIR hyperintense lesions had spontaneously disappeared and contrast-enhanced lesions had progressed, with new contrast lesions in the right corpus callosum. Repeat MRI 14 days after admission demonstrated contrast-enhancing lesions either increased or decreased in intensity in both occipitoparietal lobes. Contrast-enhancing lesions were therefore biopsied. Histopathological examination revealed vasculitis with fibrinoid necrosis. PCNSV was diagnosed without any signs of inflammation in blood vessels other than cerebral blood vessels. Spontaneously changing MRI findings may play an important role in diagnosing PCNSV.
Case Details
Disease Location
Brain
Personal Characteristics
69-year-old right-handed man
Clinical Characteristics
Presented with a sudden, unsteady gait, presumed to be due to a stroke. Initial examination revealed cognitive impairment, dysarthria, pseudobulbar palsy, and left-sided hemiparesis. Flair images showed high-signal intensity with swelling in the right deep white matter. Another MRI on day 14 demonstrated that white matter hyperintensities on flair were unchanged, whereas some contrast-enhancing lesions had exhibited either regression or spontaneous reappearance in the same site in both occipitoparietal lobes. Contrast-enhancing lesions from the right occipitoparietal lobe were biopsied on day 21. The biopsy site showed damage to the vascular wall with fibrinoid necrosis. Pcnsv was diagnosed.
Remission Characteristics
On repeat MRI 7 days later, flair hyperintense lesions that had been apparent in the right deep white matter had spontaneously disappeared and white matter hyperintensities were seen on flair surrounding bilateral post- rior horns of the lateral ventricles, appearing more prominently on the left
Treatment & Mechanisms
Proposed Remission Mechanisms
Serial changes in MRI represented the regression and progression of inflamma- tion
Clinical Treatment
Biopsy (after remission)
Non-Clinical Treatment
None reported