title: Seizure syndrome as a first manifestation of solitary tumor-like mass lesion of PACNS: Two case reports.
abstract: BACKGROUND
  Primary angiitis of the central nervous system (PACNS) is an inflammatory disease involving cerebrovascular and parenchymal, and solitary tumor-like mass lesion of PACNS (TLML-PACNS) is frequently misdiagnosed as neoplastic or other inflammatory diseases. However, seizure syndrome as a first manifestation of TLML-PACNS has rarely reported before.
  
  
  METHODS
  Here, we report 2 cases of seizure syndrome, which was the first sign that presented prior to the diagnosis of TLML-PACNS by brain biopsy.
  
  
  METHODS
  A mass lesion in the white and gray matters was detected by magnetic resonance imaging. The pathology for leptomeningeal lesion biopsy observed a transmural inflammation of the artery, with T lymphocyte infiltration. Patients were diagnosed with PACNS and epileptic seizure by biopsy and electroencephalogram.
  
  
  METHODS
  Patients were treated with glucocorticoid pulse therapy for 3 days, and subsequently oral prednisone was continued, in combination with immunosuppressant.
  
  
  RESULTS
  Luckily, both two patients were improved after treatment, and only mild cognitive impairment remained without adverse event.
  
  
  CONCLUSIONS
  Patient with mass lesion in CNS, which is similar to tumor, presented with seizure, headache, or cerebrovascular events without any other risk factors for stroke or tumor, should be considered the feasible with the disease of TLML-PACNS.
authors.affiliation: Department of Neurology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University Department of Neurology, The Fifth People's Hospital of Shanghai, Fudan University Department of Neurology, Changhai Hospital, Second Military Medical University Department of Pathology, Changhai Hospital, Second Military Medical University Department of Radiology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: De-Sheng
authors.initials: DS
authors.lastname: Zhu
authors.forename: Xiao-Li
authors.initials: XL
authors.lastname: Yang
authors.forename: Hui-Hui
authors.initials: HH
authors.lastname: Lv
authors.forename: Chen-Guang
authors.initials: CG
authors.lastname: Bai
authors.forename: Pang-Pan
authors.initials: PP
authors.lastname: Yang
authors.forename: Ze-Zhi
authors.initials: ZZ
authors.lastname: Li
authors.forename: Yong
authors.initials: Y
authors.lastname: Hao
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.forename: Yang-Tai
authors.initials: YT
authors.lastname: Guan
mesh_terms: D000328:Adult; D038524:Diffusion Magnetic Resonance Imaging; D004569:Electroencephalography; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D059906:Neuroimaging; D012640:Seizures / Q000209:etiology*; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D020293:Vasculitis, Central Nervous System / Q000150:complications / Q000175:diagnosis*; D055815:Young Adult