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      Intracranial extension of orbital inflammatory pseudotumor: a case report and literature review

      case-report

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          Abstract

          Background

          Orbital inflammatory pseudotumor is a rare inflammatory condition of unknown cause that may extend intracranially, usually as a dural-based infiltrate. Here we report the first case of orbital pseudotumor presenting with intra-axial Magnetic Resonance Imaging (MRI) changes.

          Case presentation

          A 57-year-old white female, with a 3-month history of headache and right palpebral edema, presented with marked right temporal lobe edema with ominous MRI appearance, and ipsilateral alterations of orbital and periorbital structures. Following steroid therapy, both intracranial and orbital involvement dramatically improved.

          Conclusion

          Orbital inflammatory pseudotumor with chronic inflammation may infrequently present with intracranial involvement, mimicking more aggressive diseases, even showing intra-axial enhancement after i.v. contrast administration in brain MRI. Awareness of this possibility may help neurologists to choose the appropriate therapeutic approach.

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          Most cited references26

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          Inflammatory pseudotumor.

          Lakshmana Narla, Beverley Newman, Stephanie Spottswood … (2015)
          Inflammatory pseudotumor is a quasineoplastic lesion that most commonly involves the lung and the orbit, but it has been reported to occur in nearly every site in the body. The pathogenesis, natural history, clinical presentation, imaging findings, and treatment options for inflammatory pseudotumor in the lung, heart, gastrointestinal tract, adrenal gland, iliopsoas muscle, orbit, and central nervous system are discussed. Because inflammatory pseudotumors mimic malignant tumors both clinically and radiologically, the radiologist should be familiar with this entity and help avoid unnecessary radical surgery when possible.
          Article 0 comments Cited 100 times – based on 0 reviews     Review now
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            Inflammatory pseudotumor: the great mimicker.

            Madhavi Patnana, Alexander B Sevrukov, Khaled M. Elsayes … (2012)
            The purpose of this review is to describe the pathophysiologic findings, differential diagnosis, imaging features, and management of inflammatory pseudotumor in various locations throughout the body.
            Article 0 comments Cited 91 times – based on 0 reviews     Review now
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              Perfusion and spectroscopy magnetic resonance imaging in a case of lymphocytic vasculitis mimicking brain tumor

              Carmine Muccio, Arturo Blasi, Gennaro Esposito … (2013)
              Summary Background: Lymphocytic vasculitis of the central nervous system is an uncommon subtype of primary angiitis of the central nervous system (PACNS) – a rare inflammatory disorder affecting parenchymal and leptomeningeal arteries and veins. Case Report: Establishing diagnosis on the basis of neuroimaging only is difficult, as it can mimic a brain tumor. Thus, histological diagnosis is essential for appropriate management. We present a case of biopsy-proven lymphocytic vasculitis mimicking a brain tumor on neuroimaging that was subsequently successfully treated with steroid therapy. We also discuss the findings in perfusion MR (PWI) and MR spectroscopy (MRS). Conclusions: Regional hypoperfusion on PWI and elevation of glutamate and glutamine levels on MRS (without associated typical tumor spectra) are common findings in inflammatory disorders, including PACNS, and can be useful in differential diagnosis with tumors.
              Article 0 comments Cited 29 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Enrico Tedeschi: +390817464646 , enrico.tedeschi@unina.it
                Lorenzo Ugga: lorenzo.ugga@gmail.com
                Ferdinando Caranci: ferdinandocaranci@libero.it
                Francesca Califano: giacomo.lus@unina2.it
                Sirio Cocozza: siriococozza@hotmail.it
                Giacomo Lus: giacomo.lus@unina2.it
                Arturo Brunetti: brunetti@unina.it
                Journal
                Journal ID (nlm-ta): BMC Neurol
                Journal ID (iso-abbrev): BMC Neurol
                Title: BMC Neurology
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2377
                Publication date (Electronic): 29 February 2016
                Publication date PMC-release: 29 February 2016
                Publication date Collection: 2016
                Volume: 16
                Electronic Location Identifier: 29
                Affiliations
                [ ]Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
                [ ]Department of Clinical and Experimental Internal Medicine “F. Magrassi and A. Lanzara”, Second University of Naples, Naples, Italy
                Article
                Publisher ID: 550
                DOI: 10.1186/s12883-016-0550-2
                PMC ID: 4772364
                PubMed ID: 26928524
                SO-VID: 7e453f78-a480-400a-aff4-eb57c5415af5
                Copyright © © Tedeschi et al. 2016
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 7 August 2015
                Date accepted : 24 February 2016
                Categories
                Subject: Case Report
                Custom metadata
                issue-copyright-statement © The Author(s) 2016

                ScienceOpen disciplines: Neurology
                Keywords: orbital inflammatory pseudotumor,magnetic resonance imaging,mri,orbital mass,intracranial extension
                Data availability:
                ScienceOpen disciplines: Neurology
                Keywords: orbital inflammatory pseudotumor, magnetic resonance imaging, mri, orbital mass, intracranial extension

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