title: Brain biopsy in neurologic decline of unknown etiology.
abstract: Brain biopsies have an uncertain role in the diagnosis of patients with dementia or neurologic decline of unknown etiology. They are often performed only after an exhaustive panel of less invasive tests and procedures have failed to provide a definitive diagnosis. The objective of this study was to evaluate the sensitivity of brain biopsies in this patient group through the retrospective analysis of 53 brain biopsies performed for neurologic disease of unknown etiology at a single tertiary care institution between December 2001 and December 2011. Patients with known nonlymphomatous neoplasms thought to be associated with the neurologic symptoms or with immunodeficiency were excluded from the study. Furthermore, the clinical presentation, imaging and laboratory tests were compared between diagnostic groups to identify factors more likely to yield a diagnosis. Sixty percent of the biopsies were diagnostic (32 of 53), with the most common histologic diagnosis of central nervous system lymphoma in 14 of 53 patients (26% of total) followed by infarct in four subjects (7.5%). A few patients were found to have rare and unsuspected diseases such as lymphomatosis cerebri, neurosarcoidosis and neuroaxonal leukodystrophy. Complications from biopsy were uncommon and included hemorrhage and infection with abscess formation at the biopsy site. These results suggest that brain biopsies may be useful in difficult cases in which less invasive measures have been unable to yield a definitive diagnosis.
authors: Section of Neuropathology, Department of Pathology and Laboratory Medicine, University of California, Los Angeles (UCLA) Medical Center, Los Angeles, CA 90095-1732, USA. Electronic address: smagaki@mednet.ucla.edu.
authors: Shino
authors: S
authors: Magaki
authors: Section of Neuropathology, Department of Pathology and Laboratory Medicine, University of California, Los Angeles (UCLA) Medical Center, Los Angeles, CA 90095-1732, USA.
authors: Tracie
authors: T
authors: Gardner
authors: Section of Neuropathology, Department of Pathology and Laboratory Medicine, University of California, Los Angeles (UCLA) Medical Center, Los Angeles, CA 90095-1732, USA.
authors: Negar
authors: N
authors: Khanlou
authors: Section of Neuropathology, Department of Pathology and Laboratory Medicine, University of California, Los Angeles (UCLA) Medical Center, Los Angeles, CA 90095-1732, USA.
authors: William H
authors: WH
authors: Yong
authors: Department of Radiological Sciences, University of California, Los Angeles (UCLA) Medical Center, Los Angeles, CA 90095-1732, USA.
authors: Noriko
authors: N
authors: Salamon
authors: Section of Neuropathology, Department of Pathology and Laboratory Medicine, University of California, Los Angeles (UCLA) Medical Center, Los Angeles, CA 90095-1732, USA; Department of Neurology, University of California, Los Angeles (UCLA) Medical Center, Los Angeles, CA 90095-1732, USA; Brain Research Institute, David Geffen School of Medicine at University of California, Los Angeles (UCLA) Medical Center, Los Angeles, CA 90095-1732, USA.
authors: Harry V
authors: HV
authors: Vinters
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001921:Brain / Q000473:pathology*; D002493:Central Nervous System Diseases / Q000209:etiology / Q000473:pathology*; D016543:Central Nervous System Neoplasms / Q000209:etiology / Q000473:pathology; D003704:Dementia / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Alzheimer’s disease; Brain biopsy; Central nervous system lymphoma; Dementia; Vasculitis