Clinical Problem-Solving: A 19-Year-Old Woman With Progressive Neurological Decline and Multiple Intracranial Lesions

Area of Science:

• Neurology
• Neuroimaging
• Pathology

Background:

• Multiple intracranial lesions in young adults present a broad differential diagnosis, including demyelinating, neoplastic, and infectious causes.
• A 19-year-old immunocompetent female presented with progressive headaches and aphasia, exhibiting complex neurological symptoms.

Purpose of the Study:

• To present a case study of a young adult with multiple intracranial lesions.
• To highlight a diagnostic framework for immunocompetent patients with progressive neurological decline and intracranial lesions.
• To discuss differential diagnoses and therapeutic approaches for such cases.

Main Methods:

• Brain MRI revealed multiple, large supratentorial lesions with specific signal intensities and enhancement patterns.
• Cerebrospinal fluid (CSF) analysis, serum antibody testing (neuromyelitis optica and MOGAD), and infectious work-up were performed.
• A definitive diagnosis was established through brain biopsy.

Main Results:

• MRI showed characteristic lesion features suggestive of specific pathologies.
• Initial laboratory and serological tests were inconclusive, ruling out common causes.
• Brain biopsy provided a definitive diagnosis, enabling targeted therapy.

Conclusions:

• A systematic diagnostic approach, including advanced imaging and biopsy, is crucial for rare neurological conditions.
• The case underscores the importance of considering less common etiologies in the differential diagnosis of multiple intracranial lesions.
• Effective management involves timely diagnosis and appropriate therapeutic interventions.