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Most of the literature on intra-axial lesions causing calvarial and dural destruction comes from case reports for glioblastoma, lymphoma, metastasis, and aggressive meningioma. Destruction of dura and calvaria by low-grade gliomas is extremely uncommon; cases reported so far have been mostly oligodendrogliomas. This article describes the unusual case of a 23-year-old male patient with a left-sided intra and extracranial tumor involving the frontal lobe, destroying the overlying dura and calvaria, who underwent maximal safe resection. Histopathology showed the tumor to be a low-grade astrocytoma. The calvarial thinning or remodeling caused by low-grade gliomas is thought to result from their chronic mass effect, by displacing the overlying layer of cerebrospinal fluid and transmitting brain pulsations directly to the inner table of the skull. Pressure thinning of the inner table of the skull may be caused by Pacchionian granulations close to the midline. Although this is extremely uncommon, magnetic resonance imaging may include low-grade astrocytoma in the differential diagnosis in such cases.

Vasculitis in neurosarcoidosis is rare, with only a few cases reported in the literature. We report the clinical observation of a 51-year-old patient with no previous medical history, who was admitted to the emergency department due to sudden onset confusion, fever, sweating, weakness, and headaches. The first brain scan was normal, but a further biological exam with a lumbar puncture revealed lymphocytic meningitis. A complementary cerebral MRI revealed abnormalities in the white matter signal, suggestive of multiple sclerosis, with petechial hemorrhagic foci associated with leptomeningeal involvement and cerebral vasculitis. Thoraco-abdomino-pelvic computed tomography revealed hilar and mediastinal lymphadenopathy, as well as lymph nodes in the lower cervical region. A biopsy of the lymph nodes confirmed the presence of non-caseating granulomatous inflammation consistent with sarcoidosis. Highdose corticosteroid therapy was initiated with good clinical outcomes. Cerebral vasculitis in neurosarcoidosis is rare but can lead to neurological complications requiring long-term multidisciplinary management.

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