Brain biopsy in neurologic decline of unknown etiology

Abstract

Brain biopsies have an uncertain role in the diagnosis of patients with dementia or neurologic decline of unknown etiology. They are often performed only after an exhaustive panel of less invasive tests and procedures have failed to provide a definitive diagnosis. The objective of this study was to evaluate the sensitivity of brain biopsies in this patient group through the retrospective analysis of 53 brain biopsies performed for neurologic disease of unknown etiology at a single tertiary care institution between December 2001 and December 2011. Patients with known nonlymphomatous neoplasms thought to be associated with the neurologic symptoms or with immunodeficiency were excluded from the study. Furthermore, the clinical presentation, imaging and laboratory tests were compared between diagnostic groups to identify factors more likely to yield a diagnosis. Sixty percent of the biopsies were diagnostic (32 out of 53), with the most common histologic diagnosis of central nervous system lymphoma in 14 of 53 patients (26% of total) followed by infarct in four subjects (7.5%). A few patients were found to have rare and unsuspected diseases such as lymphomatosis cerebri, neurosarcoidosis and neuroaxonal leukodystrophy. Complications from biopsy were uncommon and included hemorrhage and infection with abscess formation at the biopsy site. These results suggest that brain biopsies may be useful in difficult cases in which less invasive measures have been unable to yield a definitive diagnosis.

Lymphomatosis cerebri: diagnostic challenges and review of the literature

“…They are not associated with a mass effect. Biopsy is recommended if empirical treatment with corticosteroids and antiviral agents has not yielded clinically apparent improvement 17. However, brain biopsy may result in a non-diagnostic specimen, especially if a discrete mass or target is not evident on imaging, as in this case.…”

Two cases of rheumatoid meningitis

“…In the past, diagnosis was often made only at autopsy, but it is increasingly being diagnosed on brain biopsy, which is often performed to clarify the etiology of neurologic decline of unknown cause . Here we report two cases of RM, the first in a young man with unexplained neurologic symptoms and no history of RA, and the second in an elderly woman with a history of mild joint pain responsive to aspirin, who presented with confusion, personality changes and seizures.…”

Brain biopsy in atypical dementia and primary angiitis of the central nervous system—reply

“…In our cohort, only one patient was diagnosed as having Alzheimer disease on biopsy, which was performed because vasculitis was suspected clinically [1]. Cognitive decline was not the sole indication for biopsy but rather seen in approximately 70% of our patients and may not strictly correspond to their "atypical dementia" subgroup.…”

“…We thank the authors for their interest in our study on the use of brain biopsy in evaluating neurologic decline of unknown etiology [1].…”