We report a 68-years-old woman with systemic sclerosis and interstitial pneumonia (IP). She had developed subacute progressively encephalopathy and dementia while treated with oral cyclophosphamide and prednisolone. She admitted to our hospital because of syncope. Laboratory tests indicated slight elevated cerebrospinal fluid protein, and levels of serum C-reactive protein (CRP), levels of soluble IL-2 receptor was normal. But, magnetic resonance imaging (MRI) of the brain showed multiple infarct-like lesions mainly in the white matter, which mimics progressive multiple leukoencephalopathy (PML). Twenty days after admission, the retested MRI of the brain disclosed initial lesions progressively enlarged and numbers of the lesions were increased. The polymerase chain reaction (PCR) for JC virus of cerebrospinal fluid was negative. To make diagnosis, brain biopsy was performed. Microscopic examination revealed that small vessels were filled with lymphoma cells (CD20+, CD79+, CD3-), and intravascular lymphoma (IVL) was diagnosed. She treated with regimens of R-CHOP. After chemotherapy her consciousness and dementia were gradually improved. IVL of central nerve system (CNS) is a rare disease, and its common symptoms are ischemia, infarction and dementia. Diagnosis of IVL of CNS is difficult when the lesion mimics PML, and patient with similar laboratory examinations and radiographic findings of PML should undergo brain biopsy detected malignant cell in small vessels, which is a value of diagnosis.

Intracranial hemorrhage associated with lower grade glioma is unusual. Furthermore, pleomorphic xanthoastrocytoma (PXA) with intracranial hemorrhage, especially in a children, is extremely rare. We report here a rare case of child PXA with intracranial hemorrhage. An 11-year-old girl was admitted with headache and convulsions. A computed tomography scan demonstrated intracranial hemorrhage in the right temporal lobe. An angiogram revealed no vascular disease including arteriovenous malformation, angioma or aneurysm. Magnetic resonance (MR) imaging demonstrated no enhanced or cystic mass to suggest tumor presence. A follow-up study by MR imaging at 6 months after onset of the intracranial hemorrhage revealed a cystic mass lesion, with gadolinium-enhancement, in the right temporal lobe. This mass lesion was removed by surgery and diagnosed as PXA. Areas of tumor lesion could not be diagnosed immediately after the intracranial hemorrhage since bleeding lesion was prominent. Lower grade gliomas, including PXAs, should therefore be taken into consideration in the differential diagnosis of pediatric intracranial hemorrhage cases, separately from vascular disease and/or malignant brain tumor.

The present study reported an unusual case of temporal lobe glioblastoma (GBM) fed from the middle meningeal artery that progressed rapidly. A 66-year-old male was admitted to the Department of Neurosurgery at Nihon University Itabashi Hosipital (Tokyo, Japan) with epilepsy. Magnetic resonance imaging disclosed a small well-enhanced right middle fossa mass lesion, which was relatively boundary-clear and attached to the dura mater. An angiogram showed a stain fed from the right middle meningeal artery. The mass lesion was removed completely by surgery and diagnosed pathologically as GBM. Tumor recurrence was observed 6 months later and a second surgery was performed. Eight pieces of carmustine wafers were implanted in the tumor resection cavity at the first and second surgeries. The patient underwent a third surgery soon after the second surgery, as a cyst had formed in the resection cavity. The tumor became uncontrollable and the patient died at 11 months after the first surgery even though he had undergone multimodality treatment. Since GBM fed by the middle meningeal artery is rare, the timing of surgical treatment is difficult as it is easy to misdiagnose a case like the present one as a meningioma. Furthermore, repeated implantation of carmustine wafers should be considered carefully, since adverse events associated with such wafers may easily occur.

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Clinical dilemmas arise when patients with a non-magnetic resonance (MR) conditional pacemaker are required to undergo magnetic resonance imaging (MRI). We encountered a pacemaker patient with debilitating non-motor symptoms of Parkinson׳s disease, who required an MRI prior to deep brain stimulation (DBS) surgery. MRI was performed safely without adverse events despite the presence of a conventional pacemaker.