Brain Pathology Case of the Month - September 2002

1Katrin Lamszus M.D., 1Maria Makrigeorgi-Butera M.D., 1Rudolf Laas M.D., 2Manfred Westphal M.D., 1Dimitrios Stavrou M.D.
  1Department of Neuropathology and 2Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Germany
Published on line in September 2002


This 24 year old female presented with a history of three generalized seizures, the first of which had occurred 6 months before admission. Seizures usually occurred when she was trying to fall asleep and were characterized by contractions of both hands into fists, shaking, vomiting, cyanosis, non-responsiveness upon being addressed by her husband, and subsequent loss of consciousness. After the second seizure, which occurred 4 months after the first, she was treated with carbamazepin, however, suffered her third seizure only one month later. Ever since her last seizure she suffered from a persistent and increasing right-sided pressure headache. Neurological examination upon admission was normal.


The cranial MRI showed a small, well-circumscribed mostly cystic lesion, measuring approximately 1 x 1 cm in the left parieto-occipital region. The solid component consisted of only a thin margin involving the subcortical white matter and cortex. The lesion was hypo-intense in T1-weighted sequences (Fig. 1a) without contrast enhancement (Fig. 1b), and hyper-intense in T2-weighted sequences (Fig. 1c) without any perifocal edema. No calcification was observed. Based on the radiologic findings a low grade glioma, e.g. astrocytoma WHO grade II or ganglioglioma/gangliocytoma was suspected, and the patient was admitted for operation.


During the surgical exposure, the tumor was found not to reach the cortical surface and was localized using ultrasound. It was associated with a cyst that contained clear amber-coloured fluid. The tumor was excised completely. A tissue sample of firm, rubbery consistency and partly white, partly light brown colour was sent for histological evaluation.



International Society of Neuropathology