IMAGES IN NEUROLOGY

Intracerebral amyloidoma: imaging findings might support preoperative diagnosis

Amiloidoma intracerebral: os achados de imagem podem presumir o diagnóstico pré-operatório

Antônio José da Rocha^I; Carlos Jorge da Silva^I; José Fábio Santos Leopoldino^II; Victor Piana de Andrade^III

^IFleury Medicina e Saúde, Section of Radiology, São Paulo SP, Brazil

^IIUniversidade Federal de Sergipe, Voluntary Professor of Neurology, Aracaju SE, Brazil

^IIIFleury Medicina e Saúde, Section of Pathology, São Paulo SP, Brazil

^{Correspondence} Correspondence Carlos Jorge da Silva Centro de Medicina Diagnóstica / Setor de Imagem / Fleury Medicina e Saúde Rua Cincinato Braga 282 01333-910 São Paulo SP - Brasil. E-mail: carlos.silva@fleury.com.br

A 43-year-old woman presented a severe headache, recent right hemiparesia and disphasia. CSF analysis was unremarkable and imaging studies confirmed two expansive lesions on brain hemispheres (Fig 1). Stereotactic biopsy analysis (Fig 2) confirmed cerebral amyloid tumor (amyloidoma). There was no evidence of systemic amyloidosis, neither underlying inflammatory nor neoplastic disorder. Pathogenesis of amyloidoma remains unclear, while it is the rarest presentation of the brain involvement by amyloid proteins^1,2. Current literature has only a few previously reported cases, which describe adults with seizures, headache, focal motor signs or cognitive decline^1,2. This diagnosis should be considered in solitary or multiple intracerebral white matter masses with little or no mass effect, hyperdense on nonenhanced CT scans¹. Amyloidoma is characterized on MR images by the coexistence of a radial enhancement after gadolinium (Gd) administration associated with hypointense stripes on T2². This peculiar pattern could support the preoperative diagnosis and prevent unnecessary surgical resection.

Received 12 December 2010.

Received in final form 14 December 2010.

Accepted 21 December 2010.

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