Magnetic resonance imaging features of solitary inflammatory brain masses.
Brain lesions in inflammatory diseases may present as solitary masses, prompting a biopsy. We present neuroimaging and histologic findings in five patients with solitary, inflammatory, demyelinating mass lesions located in the supratentorial white matter and gray-white junction. The patients presented with seizures, focal neurologic signs, and neuroimaging findings that indicated the possibility of a neoplasm. Computed tomography (CT) revealed enhancing, single hypodense lesions associated with mild or no mass effect. On MRI, the lesions were hypointense on T1-weighted images and hyperintense on T2-weighted images. Variable patterns of enhancement were noted on CT and MRI, including homogeneous/patchy (n = 3) and ring/nodular (n = 1) enhancement. There was no evidence of calcification or hemorrhage. Biopsies revealed a leukoencephalitis and demyelination, with varying degrees of demyelination among the cases. The syndrome, relating to a solitary lesion, was corticosteroid-sensitive, and it ultimately stabilized. Extensive longitudinal evaluations failed to reveal multiple sclerosis, infection, or neoplasm. Solitary inflammatory lesions add to the differential diagnosis of large, supratentorial, solitary space-occupying lesions noted on CT and MRI scans.
Bakshi
R
R
Dent Neurologic Institute, Millard Fillmore Health System, School of Medicine and Biomedical Sciences, NY 14209, USA.
Glass
J
J
Louis
D N
DN
Hochberg
F H
FH
D000328:Adult; D000368:Aged; D001706:Biopsy; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D001927:Brain Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D003711:Demyelinating Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D004660:Encephalitis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed