RESUMO
BACKGROUND: Cerebral syphilitic gumma is a relatively rare clinical disease. Its clinical manifestations are non-specific, and the imaging manifestations are similar to other intracranial occupying lesions, often misdiagnosed as tumors or abscesses. There are few reports on this disease in the relevant literature. To our knowledge, we have reported the first case of cerebral syphilitic gumma misdiagnosed as a brain abscess.We report this case and provide useful information for clinical doctors on neurosyphilis diseases. CASE SUMMARY: We report the case to explore the diagnostic essentials of cerebral syphilitic gumma and attempt to mitigate the rates of misdiagnosis and missed diagnosis by equipping physicians with knowledge of neurosyphilis characteristics. The clinical diagnosis and treatment of a patient with cerebral syphilitic gumma were reported. Clinical manifestations, classifications, and diagnostic points were retrospectively analyzed. The patient was admitted to the hospital with fever and limb weakness. Brain magnetic resonance imaging showed multiple space-occupying lesions and a positive serum Treponema pallidum gelatin agglutination test. The patient was misdiagnosed as having a brain abscess and underwent a craniotomy. A postoperative pathological diagnosis of syphilis gumma was made. The patient improved and was discharged after penicillin anti-syphilis treatment. Follow-up recovery was satisfactory. CONCLUSION: Cerebral syphilitic gumma is rare in clinical practice, and it is often misdiagnosed and missed. Clinical diagnosis should be considered in combination with multiple examinations.
RESUMO
Atypical meningioma is a specific type of meningioma that is relatively rare in clinical practice. The clinical manifestations of atypical meningioma are non-specific and the imaging findings are similar to those for other intraspinal space-occupying lesions. It is usually misdiagnosed as schwannoma or metastases, and it is necessary to rely on intraoperative findings and pathological examination to confirm the diagnosis. Atypical meningioma invading the intervertebral foramen and causing bone destruction is rare. The present study describes the case of a patient with cervical intraspinal atypical meningioma combined with cervical bone destruction. A 50-year-old female patient presented with numbness of the extremities with unstable walking, and underwent magnetic resonance imaging (MRI) of the cervical spine. MRI showed a space-occupying lesion in the spinal canal at the C2-4 level. The patient underwent cervical intraspinal lesion resection, and postoperative pathology confirmed atypical meningioma (World Health Organization grade II). The patient received dehydration and hormone therapy, and was discharged after the symptoms improved. Radiotherapy was performed 2 months after discharge. Cervical MRI 3 months after the operation showed that the tumor resection was satisfactory. To the best of our knowledge, the present study is the first to report on this specific type of meningioma. The present case report may provide useful information for clinicians to diagnose and treat the disease.
RESUMO
Tumefactive demyelinating lesions (TDLs) are rare and specific types of inflammatory demyelinating lesions. Its clinical manifestations are nonspecific, and the imaging findings are similar to those of other intracranial space-occupying lesions, which are usually misdiagnosed as tumors or abscesses and require a pathologic examination to confirm the diagnosis. Tumefactive demyelinating lesions after kidney transplantation are even rarer. This article reports a case of TDLs after kidney transplantation. A 60-year-old female patient underwent kidney transplantation 15 years ago and took anti-rejection drugs such as tacrolimus, tacrolimus, and corticosteroids after surgery. The patient was admitted with headache and left limb weakness, and magnetic resonance imaging of the head showed multiple space-occupying lesions with surrounding edema. The patient underwent a stereotactic biopsy of the encephalopathy lesion, and postoperative pathology confirmed TDLs. She was treated with corticosteroids and discharged after the improvement of her symptoms. Here, to our knowledge, we report the first case of TDLs after kidney transplantation. We report this case to provide clinicians with useful information on intracranial demyelinating disease after kidney transplantation.
