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A clinical case of pseudotumorous chronic parainfectious limbic encephalitis

https://doi.org/10.14412/2074-2711-2014-3-49-54

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Abstract

Parainfectous limbic encephalitis (PILE) associated with viruses of the Herpesviridae family is one of the forms of chronic herpes encephalitis characterized by limbic system dysfunction and a prolonged course with frequent exacerbations. There are two types of the course of the disease: latent autoimmune limbic encephalitis (LE) progressing to mesial temporal sclerosis and pseudotumorous granulomatous LE. The latter (inflammatory pseudotumor or granuloma) is characterized by the formation of a polymorphic inflammatory infiltrate with the elements of fibrosis, necrosis, and a granulomatous reaction and by myofibroblast cells. This is a slowly growing benign pseudotumor that contains much more plasma cells than inflammatory ones. The diagnosis of pseudotumorous LE is difficult and requires the participation of a neurologist, an immunologist, an oncologist, and a neurosurgeon. Perfusion computed tomography, magnetic resonance imaging, and magnetic resonance spectroscopy give proof to the adequacy of the term inflammatory pseudotumor because it is histologically difficult to characterize the lesion as a tumor or inflammation. When a chronic lesion in the central nervous system is lately diagnosed, the prognosis of the disease may be poor and complicated by the development of resistant symptomatic focal epilepsy and emotional, volitional, and cognitive impairments. It was differentially diagnosed from brain tumors (astrocytic, oligodendroglial, and mixed gliomas, ependymal, neuronal, neuroglial, and embryonal tumors, meningiomas, cholesteatomas, dermoid cysts, teratomas, and cysts), other reactive and inflammatory processes (leukemic infiltrations, systemic lupus erythematosus, multiple sclerosis, encephalomyelitis), hypoparathyroidism, Addison's disease, vitamin A intoxication, and the long-term use of glucocorticoids and contraceptives. The authors describe a clinical case of the pseudotumorous course of chronic PILE in a 28-year-old woman. They discuss difficulties in differential diagnosis and the specific features of the clinical course and treatment of the disease. Inflammatory pseudotumor is an indication for surgery, but realizing the fact that this false tumor may avoid an unnecessary radical operation in some cases, which demonstrates the given clinical observation.

About the Authors

N. A. Shnaider
Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia, Krasnoyarsk, Russia Neurological Center of Epileptology, Neurogenetics, and Brain Research, University Clinic, Krasnoyarsk, Russia
Russian Federation

1, Partisan Zheleznyak St., Krasnoyarsk 660022

124 Karl Marx St., Krasnoyarsk 660021



Yu. S. Panina
Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia, Krasnoyarsk, Russia
Russian Federation
1, Partisan Zheleznyak St., Krasnoyarsk 660022


T. E. Popova
Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia, Krasnoyarsk, Russia Neurological Center of Epileptology, Neurogenetics, and Brain Research, University Clinic, Krasnoyarsk, Russia
Russian Federation

1, Partisan Zheleznyak St., Krasnoyarsk 660022

124 Karl Marx St., Krasnoyarsk 660021



References

1. Azad R, Kudesia S, Arora P. Rare case of plasma cell hyperplasia (inflammatory pseudotumor) of the central nervous system. The Internet Journal of Radiology. 2009;11(2).

2. Allan SM, Tyrrell PJ, Rothwell NJ. Interleukin-1 and neuronal injury. Nat Rev Immunol. 2005;5(8):629–40. DOI: http://dx.doi.org/10.1038/nri1664.

3. Шнайдер НА, Панина ЮС, Дмитренко ДВ и др. Параинфекционный лимбический энцефалит, ассоциированный с вирусами семейства Herpes viridae. Проблемы женского здоровья. 2014;(1):58–69. [Shnayder NA, Panina YuS, Dmitrenko DV, et al. Parainfectious limbic encephalitis associated Herpes viridae viruses. Problemy zhenskogo zdorov`ya. 2014;(1):58–69. (In Russ.)]

4. Barbetakis N, Efstathiou A, Xenikakis T, et al. An unusual cause of haemoptysis in a young male. Int Semin Surg Oncol. 2006;3:6. DOI: http://dx.doi.org/10.1186/1477-7800-3-6.

5. Narla LD, Newman B, Spottswood SS, et al. Inflammatory pseudotumor. Radiographics. 2003;23(3):719–29. DOI: http://dx.doi.org/10.1148/rg.233025073.

6. Shenoy SN, Raja A. Intracranial plasma cell granuloma. Neurol India. 2004;52(2):262–4.

7. Weber MA, Viehoever A, Stieltjes B, et al. Intracerebral manifestation of an atypical monoclonal plasma cell hyperplasia depicted by MR perfusion and diffusion tensor imaging and MR spectroscopy. Am J Roentgenol. 2005;185(3):784–7. DOI: http://dx.doi.org/10.2214/ajr. 185.3.01850784


For citation:


Shnaider N.A., Panina Y.S., Popova T.E. A clinical case of pseudotumorous chronic parainfectious limbic encephalitis. Neurology, Neuropsychiatry, Psychosomatics. 2014;6(3):49-54. (In Russ.) https://doi.org/10.14412/2074-2711-2014-3-49-54

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ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)