Abstract
The involvement of the central nervous system in case of Wegener granulomatosis (WG) is infrequent and usually leads to cranial nerve abnormalities, cerebrovascular events, and seizures. Meningeal involvement is quite rare and usually is due to the spreading from adjacent disease in the skull base. We described the case of a remote intraparenchymal Wegener's granuloma in a 55-year-old man presenting with seizures and a history of severe generalized WG. The radiological findings were not useful for the diagnosis, and the pharmacological treatment was ineffective. The importance of a surgery in case of localized WG has been emphasized, in order to confirm the diagnosis and to avoid additional medicaments, like antiepileptic drugs, potentially harmful in immunosuppressed patients.
Highlights
Primitive meningeal involvement represents one of the less frequent manifestations of Wegener granulomatosis (WG) in the central nervous system (CNS)
The differential diagnosis is challenging because no radiological findings allow to exclude other extra-axial lesions
The pharmacological treatment is often ineffective in case of brain granulomatous lesions [1,2,3,4,5]
Summary
Primitive meningeal involvement represents one of the less frequent manifestations of Wegener granulomatosis (WG) in the central nervous system (CNS). The differential diagnosis is challenging because no radiological findings allow to exclude other extra-axial lesions. The pharmacological treatment is often ineffective in case of brain granulomatous lesions [1,2,3,4,5]. We report a case of remote cerebral granuloma in a patient with a history of severe generalized WG. Clinical and radiological features are carefully described and the role of surgery is discussed
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