PMC5379810_01
(a) MRI, T1W image showing hypointense lesion in the left frontal lobe. (b and c) showing peripheral enhancement on contrast administration
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F1
T1W [Figure 1a], which was hyper-intense on T2W, with disproportionate edema. T1W Gadolinium contrast study showed ring and central enhancement of the lesion. Abnormal enhancement of adjacent vessels and the falx was also noted [Figure 1b and c].
MR spectroscopy showing increased choline creatinine ratio and increased choline NAA ratio which is suggestive of glioma
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F2
MR spectroscopy showed increased lipid peak. Multi-voxel spectroscopy showed reduced N-acetylaspartate (NAA) and increased choline peak, with increased choline/creatinine ratio adjacent to lesion, which is suggestive of infiltration [Figure 2].
The vessels showing perivascular infiltrate of lymphocytes and neutrophils causing wall destruction. H and E, x100
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F3
Stains for tuberculous bacilli and fungi were negative [Figure 3].
MR angiography in the postoperative period shows focal narrowing of vessels in the left frontal region, indicating vasculitis
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F4
MR angiography done postoperatively showed focal narrowing of the vessels in the left frontal region, suggestive of vasculitis [Figure 4].