Differential diagnosis of a vanishing brain space occupying lesion in a child.

摘要: We describe clinical, diagnostic features and follow up of a patient with vanishing brain lesion. A 14-year-old child admitted to the department Neurology at September 2009 history subacute onset fever, anorexia, vomiting, blurring vision right hemiparesis since one month. Magnetic resonance imaging (MRI) revealed presence intra-axial large mass (25 mm × 19 mm) in left temporal lobe brainstem which showed hypointense signal T1W hyperintense signals T2W fluid attenuated inversion recovery (FLAIR) images homogenously enhanced gadolinium (Gd). It was surrounded by vasogenic edema effect. Intravenous antibiotics, mannitol (2 g/12 h per 2 d) dexamethasone (8 mg/12 h) were given relief manifestations increased intracranial pressure. Whole craniospinal radiotherapy (brain = 4000 CGy/20 settings 4 wk; Spinal 2600/13 3 wk) based on high suspicion neoplastic lesion (lymphoma or glioma). Marked clinical improvement (up complete recovery) occurred within 15 d. Tapering steroid dose done over next mo. Follow MRI after mo small antero-medial region FLAIR but did not enhance Gd. At August 2012, developed recurrent generalized epilepsy. His electroencephalography focus epileptic activity. same as described up. The diffusion weighted normal. seizures frequency decreased carbamazepine therapy (300 h). October 2014, single voxel proton (1H) MR spectroscopy (MRS) reduced N-acetyl-aspartate (NAA)/creatine (Cr), choline (Cho)/Cr, NAA/Cho ratios consistent absence neoplasm highly suggested gliosis. solitary poses considerable difficulty. MRS provided valuable differentiation between tumor pseudotumor lesions.