Stroke-like onset of calcified brain metastases with Wallerian degeneration: a case report and review of the literature

Abstract

Introduction

Metastatic brain tumors are a common complication of systemic cancer. They tend to have a chronic onset and are located at the gray-white junction of the cerebral hemispheres, those larger than 9.4 mm in diameter are often accompanied by substantial vasogenic edema. Herein, we report a rare case of calcified metastatic adenocarcinoma with Wallerian degeneration. In addition, we discuss the atypical manifestations of brain metastases.

Case report

A 71-year-old man who went through stroke-like onset twice during 8 months with a history of resection of the left pulmonary adenocarcinoma 5 years prior was examined. Diffusion weighted magnetic resonance imaging of the brain showed an enlarged open-ring-shaped hyperintensity on the left periventricular white matter and basal ganglia, with Wallerian degeneration on the left cerebral peduncle. Brain computed tomography revealed nodular calcification of the lesion. The pathology of stereotactic biopsy indicated metastatic adenocarcinoma.

Conclusion

When patients present with acute nervous system symptoms and a previous history of cancer, the possibility of metastases should be considered, even if neuroimaging is atypical.

Keywords:

• Brain metastases
• calcification
• Wallerian degeneration
• edema
• neuroimaging

Acknowledgments

We would like to thank Editage (www.editage.com) for English language editing.

Author contributions

Yejia Mo drafted the original manuscript. Yinxi Zhang, Liying Zhuang, and Qilun Lai contributed to data acquisition and revised the manuscript. Junjun Wang, Sicheng Yan, Yaguo Li, and Song Qiao revised the manuscript. Qilun Lai reviewed and edited the final version of the manuscript. All authors have contributed to the manuscript and approved the submitted version.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics approval

The case report was approved by the Ethics Committee of Zhejiang Hospital for Human Research. (Approval number: 2022-CA-19)

Informed consent

Written informed consent was received from the patient.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.