We describe clinical, diagnostic features and follow up of a patient with a vanishing brain lesion. A 14-yearold child admitted to the department of Neurology at September 2009 with a history of subacute onset of feve...We describe clinical, diagnostic features and follow up of a patient with a vanishing brain lesion. A 14-yearold child admitted to the department of Neurology at September 2009 with a history of subacute onset of fever, anorexia, vomiting, blurring of vision and right hemiparesis since one month. Magnetic resonance imaging(MRI) of the brain revealed presence of intraaxial large mass(25 mm × 19 mm) in the left temporal lobe and the brainstem which showed hypointense signal in T1 W and hyperintense signals in T2 W and fluid attenuated inversion recovery(FLAIR) images and homogenously enhanced with gadolinium(Gd). It was surrounded by vasogenic edema with mass effect. Intravenous antibiotics, mannitol(2 g/12 h per 2 d) and dexamethasone(8 mg/12 h) were given to relief manifestations of increased intracranial pressure. Whole craniospinal radiotherapy(brain = 4000 CGy/20 settings per 4 wk; Spinal = 2600/13 settings per 3 wk) was given based on the high suspicion of neoplastic lesion(lymphoma or glioma). Marked clinical improvement(up to complete recovery) occurred within 15 d. Tapering of the steroid dose was done over the next 4 mo. Follow up with MRI after 3 mo showed small lesion in the left antero-medial temporal region with hypointense signal in T1 W and hyperintense signals in T2 W and FLAIR images but did not enhance with Gd. At August 2012, the patient developed recurrent generalized epilepsy. His electroencephalography showed the presence of left temporal focus of epileptic activity. MRI showed the same lesion as described in the follow up. The diffusion weighted images were normal. The seizures frequency was decreased with carbamazepine therapy(300 mg/12 h). At October 2014, single voxel proton(1H) MR spectroscopy(MRS) showedreduced N-acetyl-aspartate(NAA)/creatine(Cr), choline(Cho)/Cr, NAA/Cho ratios consistent with absence of a neoplasm and highly suggested presence of gliosis. A solitary brain mass in a child poses a considerable diagnostic difficulty. MRS provided valuable diagnostic differentiation between tumor and pseudotumor lesions.展开更多
文摘We describe clinical, diagnostic features and follow up of a patient with a vanishing brain lesion. A 14-yearold child admitted to the department of Neurology at September 2009 with a history of subacute onset of fever, anorexia, vomiting, blurring of vision and right hemiparesis since one month. Magnetic resonance imaging(MRI) of the brain revealed presence of intraaxial large mass(25 mm × 19 mm) in the left temporal lobe and the brainstem which showed hypointense signal in T1 W and hyperintense signals in T2 W and fluid attenuated inversion recovery(FLAIR) images and homogenously enhanced with gadolinium(Gd). It was surrounded by vasogenic edema with mass effect. Intravenous antibiotics, mannitol(2 g/12 h per 2 d) and dexamethasone(8 mg/12 h) were given to relief manifestations of increased intracranial pressure. Whole craniospinal radiotherapy(brain = 4000 CGy/20 settings per 4 wk; Spinal = 2600/13 settings per 3 wk) was given based on the high suspicion of neoplastic lesion(lymphoma or glioma). Marked clinical improvement(up to complete recovery) occurred within 15 d. Tapering of the steroid dose was done over the next 4 mo. Follow up with MRI after 3 mo showed small lesion in the left antero-medial temporal region with hypointense signal in T1 W and hyperintense signals in T2 W and FLAIR images but did not enhance with Gd. At August 2012, the patient developed recurrent generalized epilepsy. His electroencephalography showed the presence of left temporal focus of epileptic activity. MRI showed the same lesion as described in the follow up. The diffusion weighted images were normal. The seizures frequency was decreased with carbamazepine therapy(300 mg/12 h). At October 2014, single voxel proton(1H) MR spectroscopy(MRS) showedreduced N-acetyl-aspartate(NAA)/creatine(Cr), choline(Cho)/Cr, NAA/Cho ratios consistent with absence of a neoplasm and highly suggested presence of gliosis. A solitary brain mass in a child poses a considerable diagnostic difficulty. MRS provided valuable diagnostic differentiation between tumor and pseudotumor lesions.
