- Department of Neurosurgery, Walton Centre for Neurology and Neurosurgery, Lower Lane, L9 7LJ, UK
- Department of Neuropathology, Walton Centre for Neurology and Neurosurgery, Lower Lane, L9 7LJ, United Kingdom
Department of Neurosurgery, Walton Centre for Neurology and Neurosurgery, Lower Lane, L9 7LJ, UK
DOI:10.4103/2152-7806.110651Copyright: © 2013 Patel A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Patel A, Rathi N, Lee MK, Baborie A, Jenkinson MD. Intracranial granuloma mimicking a brain tumor in a patient with scleroderma. Surg Neurol Int 18-Apr-2013;4:54
How to cite this URL: Patel A, Rathi N, Lee MK, Baborie A, Jenkinson MD. Intracranial granuloma mimicking a brain tumor in a patient with scleroderma. Surg Neurol Int 18-Apr-2013;4:54. Available from: http://sni.wpengine.com/surgicalint_articles/intracranial-granuloma-mimicking-a-brain-tumor-in-a-patient-with-scleroderma/
Background:Intracranial granulomatous masses presenting as space occupying lesions, although rare, have been described in the literature. Causes include infections, systemic granulomatous disorders, and iatrogenic from previous surgery. We present a case demonstrating that spontaneous intracranial granuloma can exist, often mimicking a brain tumor.
Case Description:A 62-year-old female presented with a short history of left sided partial seizures and a left hemiparesis. Magnetic resonance imaging revealed a right sided parafalcine lesion. Histopathology demonstrated chronic inflammation of granulomatous type. She responded to steroid treatment.
Conclusion:She responded to steroid treatment. Our case demonstrated that spontaneous intracranial granuloma exists. Although rare, it should be considered in patients presenting with space occupying lesions. They can successfully be managed with steroid treatment.
Keywords: Granuloma, intracranial, scleroderma
Intracranial granulomas presenting as space occupying lesions and can cause focal neurology and imaging may mimic that of tumor.
A 62-year-old female presented with a 3 month history of partial seizures, affecting the left arm and neck, lasting 2-3 minutes at a time. She also complained initially of some left arm clumsiness and weakness, which had progressed to include left leg weakness. Neurological examination revealed a left sided hemiparesis. She had significant past medical history, which included scleroderma, interstitial lung disease, pulmonary hypertension, and renal impairment. She was taking the immunosuppressant mycophenolate for interstitial lung disease. Magnetic resonance imaging [
Histopathological examination of the stereotactic biopsies [
She completed a 3-week course of dexamethasone, 2 mg twice a day, and the hemiparesis resolved completely. Her initial seizures were managed with levetiracetam 500 mg twice a day. Follow-up imaging at 2 months [
We report a case of spontaneous intracranial granuloma mimicking a tumor, with no precipitant that resolved with dexamethasone, which we believe to be of de novo occurrence. This is the first reported case of a spontaneous intracranial granulomatous lesion.
Parafalcine lesions pose challenges when establishing a diagnosis. Dural-based metastases or meningioma are the main extra-axial tumors to consider. Mumert, et al.[
Intracranial granulomatous lesions of iatrogenic cause have been documented in the literature. There is a varied time course to presentation from months to years. Signs and symptoms relate to anatomical location as well as speed of growth. Dural tent sutures,[
Intracranial granuloma space occupying lesions, in the context of systemic granulomatous disease can also manifest as either a first presentation or extension or evolution of preexisting extra-cranial disease. Sarcoid is the most common and lesions demonstrate classical noncaseating histology. Lesions vary in ‘severity’, from simple sarcoid to a necrotizing type, which can be differentiated histologically.[
Intracranial granuloma can manifests as a response to infection. Tuberculosis is the most common cause and central nervous system involvement includes tuberculous meningitis, abscesses or discrete tuberculomas, either multiple or solitary.[
Parafalcine lesions pose a diagnostic challenge based on imaging alone. In patients taking immunosuppressants, nontumor alternatives should be considered. Spontaneous intracranial granuloma exists and should be considered in the patient who presents with a space occupying lesion and who does not demonstrate infection, extracranial granulomatous disease, or has undergone a previous neurosurgical procedure.
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