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Cerebral Wegener's granuloma: surgery mandatory for diagnosis and treatment
Federico Nicolosi1, Giovanni Nodari, Giannantonio Spena
1Division of Neurosurgery, Department of Neuroscience, University of Brescia, Brescia, Italy.
Abstract:
The involvement of the central nervous system in case of Wegener granulomatosis (WG) is infrequent and usually leads to cranial nerve abnormalities, cerebrovascular events, and seizures. Meningeal involvement is quite rare and usually is due to the spreading from adjacent disease in the skull base. We described the case of a remote intraparenchymal Wegener's granuloma in a 55-year-old man presenting with seizures and a history of severe generalized WG. The radiological findings were not useful for the diagnosis, and the pharmacological treatment was ineffective. The importance of a surgery in case of localized WG has been emphasized, in order to confirm the diagnosis and to avoid additional medicaments, like antiepileptic drugs, potentially harmful in immunosuppressed patients.
Insights
Wegener granulomatosis rarely affects the brain, but this case highlights a brain lesion causing seizures. Surgery confirmed the diagnosis and avoided harmful medications in this immunosuppressed patient.
Area of Science:
- Neurology
- Immunology
- Pathology
Background:
- Central nervous system involvement in Wegener granulomatosis (WG) is uncommon.
- Meningeal and intraparenchymal WG are rare, often arising from contiguous spread.
- WG can manifest with neurological symptoms like seizures and cranial nerve deficits.
Purpose of the Study:
- To report a rare case of intraparenchymal Wegener granuloma presenting with seizures.
- To emphasize the diagnostic challenges and therapeutic implications of CNS WG.
- To highlight the role of surgical intervention in localized WG.
Main Methods:
- Case report of a 55-year-old male with generalized WG and new-onset seizures.
- Review of radiological findings and response to pharmacological treatment.
- Surgical resection of the intraparenchymal lesion for diagnosis and treatment.
Main Results:
- Radiological imaging was inconclusive for diagnosing the intraparenchymal lesion.
- Pharmacological treatment, including antiepileptic drugs, proved ineffective.
- Surgical intervention successfully confirmed the diagnosis of Wegener granuloma.
Conclusions:
- Surgical resection is crucial for diagnosing localized CNS Wegener granulomatosis.
- Early surgical intervention can prevent the need for potentially harmful long-term medications in immunosuppressed patients.
- This case underscores the importance of considering WG in the differential diagnosis of brain lesions, even in the absence of typical symptoms.
