PubMed · 14859180
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E L RUTHERFORD. 1951. Weaving.. https://pubmed.ncbi.nlm.nih.gov/14859180/
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Intraoperative high-field MRI with integrated microscope-based neuronavigation is a safe and reliable technique providing immediate intraoperative quality control. Major indications are pituitary tumor, glioma, and epilepsy surgery. Intraoperative high-field MRI provides intraoperative anatomic images at high quality that are up to the standard of pre- and postoperative neuroradiologic imaging. Compared with previous low-field MRI systems used for intraoperative imaging, not only is the image quality is clearly superior but the imaging spectrum is much wider and the intraoperative work flow is improved. Furthermore, high-field MRI offers various modalities beyond standard anatomic imaging, such as magnetic resonance spectroscopy, diffusion tensor imaging, and functional MRI.
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OBJECTIVE AND IMPORTANCE: The first case of histologically proven hemophagocytic lymphohistiocytosis (HLH) isolated to the central nervous system (CNS) is reported. HLH affecting the CNS mimics several neurological disorders and may be misdiagnosed. The diagnostic and therapeutic problems of this disease are discussed. CLINICAL PRESENTATION: We report a case of a 5-year-old girl with a 2-month history of right hemiparesis. The initial magnetic resonance imaging scan mimicked the appearance of malignant glioma or cerebral infarction. By use of neuroimaging alone, it was extremely difficult to reach an appropriate diagnosis. INTERVENTION: Pathological examination of a surgical specimen of the lesion revealed histological characteristics typical of HLH. Because of the absence of both physical and blood chemical findings of systemic HLH, the patient was diagnosed as having HLH isolated in the CNS without systemic HLH. Radiotherapy with corticosteroid administration led to complete resolution of the CNS lesions, but the duration of remission was only 3 months. The patient died secondary to refractory progression of the CNS lesion. CONCLUSION: Radiotherapy with corticosteroid administration led to a complete resolution of the lesions, although for only a transitory remission. Although HLH is extremely rare, the existence of this disease isolated in the CNS should be documented, and further case accumulation and therapeutic investigations are needed to clarify the pathophysiological characteristics of this disease.