Freiburg Neuropathology Case Conference: Multiple Small Ring-Enhancing Lesions in a 75-Year-Old Patient

Excerpt

A 75-year-old female patient presented at the Emergency Department of the University Medical Center with severe headache, predominantly behind the right forehead, fatigue, speech impairment, and dysgraphia that had developed over several weeks. A CT scan of the head without contrast revealed a large edema in the right frontal lobe, suspicious of an underlying space-occupying lesion. Her medical history included Sjögren syndrome, autoimmune thyroiditis, mixed polyneuropathy, lumbar disc disease, and recurrent urinary infections, but no cancer or history of infection and no trips to foreign countries or exposure to animals. On admission to the Department of Neurosurgery, she was afebrile and leukocyte count and C-reactive protein level were normal; she had a mild left-sided facial paresis. MRI with contrast showed a contrast-enhancing right frontal polycystic lesion with perifocal edema. …