Early cerebritis resulting in a first-time seizure in an otherwise healthy young man.

Abstract

We report the case of an otherwise healthy 28-year-old-man who presented with a first-time seizure. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a circumscribed left frontal lobe heterogeneous mass most consistent with a neoplasm. He underwent left supraorbital craniotomy with mass resection of the lesion, with histopathology of the brain tissue revealing heightened cellularity with perivascular neutrophilic predominance and neutrophils percolating through the brain parenchyma and surrounding cortical neurons, most consistent with a diagnosis of early cerebritis. He completed six weeks of empiric antimicrobial therapy with resolution of his seizures. Early cerebritis, which was elegantly demonstrated on histopathology in this case, is an uncommon diagnosis as patients typically present later with progressive disease and signs and symptoms reflective of an underlying brain abscess.