Tumor-mimicking primary CNS vasculitis: illustrative case.

Area of Science:

• Neurology
• Neuroradiology
• Oncology

Background:

• Primary CNS vasculitis (PCNSV) can present with symptoms and imaging findings similar to brain tumors.
• Misdiagnosis leads to delays in appropriate treatment and impacts patient prognosis.
• Differentiating PCNSV from tumors is critical for effective management.

Purpose of the Study:

• To highlight the diagnostic challenges posed by tumor-mimicking PCNSV.
• To review the clinical features, diagnostic methods, and outcomes of PCNSV that resembles tumors.
• To provide insights for clinicians managing such complex cases.

Main Methods:

• Case report of a 35-year-old male with stroke-like symptoms initially suspected as glioma.
• Literature review of 63 patients diagnosed with tumor-mimicking PCNSV.
• Analysis of clinical presentations, MRI findings, histology, treatment, and outcomes.

Main Results:

• Tumor-mimicking PCNSV presented commonly with focal deficits (62%) and headaches (52%).
• MRI typically showed T2/FLAIR-hyperintense lesions with edema and variable enhancement.
• Lymphocytic vasculitis was the most common histological finding (76%); 92% received high-dose steroids.

Conclusions:

• Tumor-mimicking PCNSV presents a significant diagnostic challenge in clinical practice.
• Recognizing the varied presentations of PCNSV is essential for prompt diagnosis.
• Appropriate clinical management depends on accurate differentiation from neoplastic lesions.