PECULIARE EVOLUZIONE DELLA SEMEIOTICA NEURORADIOLOGICA DI UN CASO DI MALATTIA DEMIELINIZZANTE CON LESIONI PSEUDOTUMORALI

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Abstract

[automatically translated] SCOPE OF WORK We present a case of a 24 year old patient who comes to our attention to the appearance of dysarthria as clinical debut of an aggressive form of demyelinating disease of which it is estimated the atypical evolution of pseudotumoral neuroradiological lesions that characterize and possible differential diagnoses. MATERIALS AND METHODS The patient after a first evaluation in PS was subjected to CT head, admitted to the Unit of Neurology, underwent MRI seriated controls (even with advanced techniques); during hospitalization it was also carried out a stereotactic biopsy. RESULTS The TC took over at least three hypodense lesions: on the left, in the subcortical white matter of frontal and parietal white matter in the deep, right, in the paratrigonale. The last two, a diagnostic study with MRI, showed a slightly baggy, high signal in the sequences with long TR and a labrum incomplete enhancement after contrast. The front lesional area, however, considerably more extensive than the others, showed a more mixed signal in the long weighings TR (as constituted by more focal lesions tending to confluence), restriction of diffusion in the ADC in the absence of enhancement after contrast. The latter injury, subsequent checks has finally appalesata, around the first months of clinical onset, like a big pseudotumorale lesion enhancement however atypical for demyelinating disease. CONCLUSIONS The clinical presentation, lumbar puncture and MRI semiotics of smaller lesions were consistent with a framework of demyelinating disease; However, it was not possible to exclude that the large lesion in the left front seat could have other nature. The diagnostic hypothesis of a form of demyelinating disease in our case was confirmed by stereotactic biopsy, performed in view of the lack of response to steroid therapy and medical severity of the peculiar inexorably worsening the clinical picture. Histological examination, in the fragments of bioptizzato brain tissue, areas of demyelination, negative were identified for myelin basic protein (MBP), isolated T lymphocytes (CD3 +) and reactive astrocytosis. Demyelinating lesions pseudotumoral pose many problems of differential diagnosis. Our case, seems exceptional in the literature for the singular evolution of most of lesion size,
Original languageItalian
Number of pages1
Publication statusPublished - 2013

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