PMC7668556_01
CT head showing large frontotemporal intracranial hemorrhage.
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F1
A right frontotemporal intracerebral hemorrhage (49 ml) was noted on CT with intraventricular hemorrhage and midline shift (Figure 1).
H&E stained sections reveal portions of CNS tissue including leptomeninges, cortex, and subcortical white matter. Numerous non necrotizing granulomas are seen involving predominantly small, medium and rare large-sized blood vessel walls in the leptomeninges and CNS parenchyma. In addition, occasional blood vessels with evidence of vascular damage in the form of active necrotizing vasculitis are seen.
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F2
Surgical pathology obtained during second surgery demonstrated leptomeningeal and superficial cortical vessels to be involved by an active vasculitis showing a prominent granulomatous component, favoring PACNS (Figure 2).