Brain stones revisited—between a rock and a hard place

Abstract

Objectives and methodsLarge intracranial calcifications are occasionally encountered in routine computed tomography (CT) scans of the brain. These calcifications, also known as “brain stones”, can be classified according to location and aetiology. Combining imaging findings with relevant clinical history and physical examination can help narrow down the differential diagnosis and may allow confident diagnosis in certain situations.ResultsThis article provides a pictorial review illustrating various clinical entities resulting in brain stones.DiscussionBased on location, brain stones can be classified as extra- or intra-axial. Extra-axial brain stones comprise tumours and exaggerated physiological calcifications. Intra-axial brain stones can further be classified according to aetiology, namely neoplastic, vascular, infectious, congenital and endocrine/metabolic. Imaging findings combined with essential clinical information can help in narrowing the differential diagnosis, determining disease state and evaluating effect of therapy.Teaching Points• Based on location, brain stones can be either extra- or intra-axial.• Extra-axial brain stones comprise tumours and exaggerated physiological calcifications.• Intra-axial aetiologies include neoplastic, vascular, infectious, congenital and endocrine/metabolic.• CT scan is the mainstay in identifying and characterising brain stones.• Certain MRI sequences (gradient echo T2* and susceptibility-weighted imaging) are considered adjunctive.

Multiple osteomas of the falx cerebri and anterior skull base: case report

“…3D CT reconstruction capabilities offer a more specific and accurate localiza- multiple intracranial osteomas tion of the lesion with detailed delineation of its osseous morphology. 6 Intracranial osteomas are extremely rare. They are usually meningeal based and arise along the convexity.…”

Brain Studded with Innumerable Larger Stones: Starry Sky at Night Appearance: Multiple Calcified Giant Tuberculoma with 15 Years of Follow-up

“…CNS involvement in tuberculosis is usually caused by hematogenous spread from either the lungs or gastrointestinal tract, which in the beginning causes formation of small subpial or subependymal infective focus also called Rich focus and acts as a reservoir from which intracranial spread can subsequently occur either during the primary infection or later as reactivation causing a postprimary infection. [1][2][3] CNS tuberculosis is usually secondary to hematogenous dissemination of bacilli from an infection focus elsewhere in the body. All intracranial compartments can be affected.…”

“…It is usually located supratentorial in adults and infratentorial in children. 2 Intracranial tuberculomas are usually seen in the basal section of the brain. Tuberculoma may show a spectrum of clinical manifestations depending on location, size, associated edema, number of tuberculoma, and obstruction to cerebrospinal fluid (CSF) pathway.…”

Six different extremely calcified lesions of the brain: brain stones

“…Intra-axial stones can be caused by neoplastic [oligodendroglioma, medulloblastoma, primitive neuroendocrine tumors (PNETs), dysembryoplastic neuroendocrine tumors (DNETs), and ganglioglioma], vascular [cavernous malformations, arteriovenous malformations (AVMs), and chronic vasculitis], infectious [TORCH, cytomegalovirus (CMV), herpes simplex virus (HSV), and parasites], congenital [Sturge–Weber syndrome and neurofibromatosis (NF)], endocrine, or metabolic (Fahr’s syndrome and hyperparathyroidism) factors (Celzo et al 2013). Tumorous and vascular factors are prevalent causes of intra-axial stones, whereas meningiomas constitute an important portion of extra-axial stones (Celzo et al 2013). The deterioration of calcium regulation is the primary reason for stone development.…”

“…When vascular factors are prevalent, calcium regulation deteriorates in association with chronic venous ischemia. Intracellular calcium build-up increases, thus resulting in dystrophic calcification (Celzo et al 2013). …”