Cerebral Granuloma Mimicking Malignant Neoplasm in Patient with Seizures 21 Years After Head Trauma

Chronic posttraumatic cerebral granuloma is a rare, delayed complication of traumatic brain injury. Because of its late onset of symptoms and atypical appearance, the correct diagnosis of this rare lesion is difficult.

A 49-year-old man presented with seizures, which occurred 21 years after open right forehead trauma. Imaging techniques, such as magnetic resonance imaging and magnetic resonance spectroscopy, which indicated a malignant neoplasm, revealed a mass lesion on the right frontal lobe, invading the dura and partial frontal bone. The patient underwent total removal of the lesion and titanium mesh cranioplasty, simultaneously, due to invasion of the mass lesion into the skull. However, the postoperative histopathologic diagnosis was chronic inflammatory granuloma. At 1-year follow-up, he did not have any discomfort and epilepsy did not recur.

Chronic cerebral granuloma should be considered in the differential diagnosis of a novel or recurrent mass detected in patients with a history of traumatic brain injury or prior surgery. Moreover, the retained foreign bodies in the superficial or nonfunctional area of the brain should be thoroughly examined and removed at the time of injury, particularly in open brain trauma.