JAMA Clinical Challenge |

Multiple Cerebral Infarctions and Intracranial Vessel Abnormalities

Eline A. Oudeman, MD1; Catharina J. M. Frijns, MD, PhD1; Catharina J. M. Klijn, MD, PhD1
[+] Author Affiliations
1Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands
JAMA. 2013;310(24):2668-2669. doi:10.1001/jama.2013.284467.
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Figure 1.

A, Axial MRI using fluid-attenuated inversion recovery (left) demonstrating hyperintense multifocal lesions involving mainly the subcortical white matter; axial diffusion-weighted MRI (right) showing hyperintense lesions consistent with recent infarctions. B, Digital subtraction angiography of the intracranial vessels showing widespread areas of vessel wall irregularity, which consist of zones of focal stenosis and luminal tapering in many third-order and fourth-order branches.

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Figure 2.

Left occipital brain biopsy specimen (original magnification ×200). A, Hematoxylin-eosin stain showing large, atypical, pleomorphic cells with large nuclei within the capillaries. B, Tumor cells in the vessel are highlighted (brown) by immunohistochemical staining for CD20 capillaries.

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