Granulomatous angiitis of the brain: a successfully treated case

A patient with clinical and radiographic findings initially suggesting a neoplasm was diagnosed as having Hodgkin disease. Computerized axial tomography demonstrated profound diffuse decreased density similar to that seen in cases of cerebral edema or leukomalacia. Cerebral angiography showed blood vessels with a beaded appearance. A diagnosis of granulomatous angitis was made on the basis of brain biopsy specimens. Viral cultures were negative. Skin testing revealed poor response to antigens. The patient improved dramatically following a combination of radiotherapy and steroid therapy. Resolution of the low-density abnormally seen on serial EMI scanning and resolution of the vasculitis demonstrated in the post-therapy brain biopsy specimen was dramatic. This is the first case of granulomatous angitis of the brain diagnosed during life, and it points out the value of radiation and steroid therapy for relief of neurologic symptoms.