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Benign focal cerebral vasculitis: case report

J R Berger1, J Romano, M Menkin

  • 1Department of Neurology, University of Miami School of Medicine, FL, USA.

Neurology
|September 1, 1995
PubMed

Insights

This case study highlights a rare instance of focal cerebral vasculitis in a 47-year-old man presenting with partial seizures. The condition showed a benign course, suggesting it may represent a milder form of primary central nervous system vasculitis.

Area of Science:

  • Neurology
  • Immunology
  • Pathology

Background:

  • Focal cerebral vasculitis is a rare condition affecting blood vessels in the brain.
  • Primary angiitis of the central nervous system (PACNS) encompasses inflammatory conditions of CNS blood vessels.
  • Understanding the spectrum of PACNS is crucial for accurate diagnosis and management.

Observation:

  • A 47-year-old man presented with partial seizures attributed to focal cerebral vasculitis in the right temporal lobe.
  • Excisional biopsy revealed small vessel fibrinoid necrosis with inflammatory cell infiltration (neutrophils, eosinophils, lymphocytes, plasma cells).
  • No specific etiology for the vasculitis was identified despite comprehensive investigation.

Findings:

  • The patient experienced a benign clinical course over 4.5 years without immunosuppressive therapy.
  • The primary neurological deficit was an incongruous left homonymous hemianopia.
  • Cranial magnetic resonance imaging showed only postoperative changes, indicating resolution of the active inflammatory process.

Implications:

  • This case suggests that focal neurological lesions and an indolent course can be part of the spectrum of primary angiitis of the central nervous system.
  • It underscores the importance of considering vasculitis in the differential diagnosis of focal brain lesions, even with atypical presentations.
  • The findings may prompt a re-evaluation of diagnostic criteria and treatment strategies for PACNS, particularly for focal variants.

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