Homonymous hemianopsia and headache with mass-like lesion

A 64-year-old woman presented to our hospital with a 2-week history of visual disturbance and headaches. She was diagnosed as having retroperitoneal fibrosis and being in remission for 2 years. Examination revealed left homonymous hemianopsia, but her pupil reaction was normal. She neither had a fever nor neck stiffness. Her white blood cell count, D-dimer, prothrombin time and activated partial thromboplastin time were within normal range and C reactive protein was 1.5 mg/L (normal<1.4). Serum immunoglobulin G4 (IgG4) levels were 43.7 mg/dL (normal 4.8–105.0) and tests for anti-neutrophil cytoplasmic antibody (ANCA) were negative. Cerebrospinal liquid showed 79 nucleated cells per μL, positive atypical lymphocytes, protein concentration of 86 mg/dL (normal 0–49) and glucose concentration of 91 mg/dL (normal 45–75). Blood and CSF cultures were negative. Initial MRI of the brain showed signal abnormalities extending from the right occipital lobe to the temporal and parietal lobes (figure 1A). Positron emission tomography (PET)-CT...
Source: Annals of the Rheumatic Diseases - Category: Rheumatology Authors: Tags: ARD, Images in rheumatology Source Type: research