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.