Accompanying text
Cystic lesion of brain can present in several diseases, such as inflammatory and demyelinating disorders, bacterial and fungal infections, parasitic disease, but also as metastases and primary brain tumor.1
We present a case of a 62-year-old otherwise healthy male presented with severe headache for a several weeks. Neurologic examination revealed a mild dysdiadochokinesia. Magnetic resonance imaging (MRI) demonstrated supra- and infratentorial disseminated cystic lesions, which lead to generalized cerebral edema. Radiographic appearance was suggestive of neuroparasitic disease, such as Toxoplasmosa, Neurocysticercosis, Echinococcosis.
Routine blood test showed elevated white blood cell counts and normal C-reactive Protein (CRP) values. Blood cultures and screening tests for Toxoplasmosis, Neurocysticercosis, Echinococcosis and Toxocara returned negative. Immunserological findings revealed a relevant increased ANA titer.
As a definitive diagnosis remained elusive, open neuronavigated brain biopsy of right frontal lesion was performed. Histopathological analysis revealed a brain metastasis of an adenocarcinoma. Chest CT revealed a 2,7 x 1,9 x 2,3 cm large tumor in the right lower lobe bronchus.
After the diagnosis was confirmed, the patient underwent whole brain radiotherapy (WBRT), followed by chemotherapy. A follow-up MRI of brain showed clearly decreasing Metastases supra- and infratentorial with decreasing perifocal edema. The patient has no new neurological deficits.
CONFLICT OF INTEREST
Authors have no conflict of interest to disclose.
Conflict of interest: Authors have no conflict of interest do disclose.
Author contributions: DJ: wrote the manuscript. HK and NK: editing and proofread the manuscript. FR: supervision.