Interesting case - 1.29.2012

Here's a case that I've been wanting to post for awhile, but I held out for some time, as I wanted to include the slide in the first annual "LLUMC Holiday Neuropathology Challenge" (Thanks to Dr. Jack Raisanen at UTSW for the inspiration!). Now that the competition is over, and the champions have been announced, I can go ahead and share the case.

This was an autopsy brain from a 8-year-old male who died from sequelae of congenital heart disease. At one point, a possible intracranial vascular malformation was suspected, so he underwent cerebral angiography, which was negative. His terminal course was characterized by circulatory collapse. Examination of the histologic sections from the midbrain disclosed the abnormality below...

The remainder of the brain parenchyma was free of inflammation, hypoxic/ischemic changes, etc...

This lesion is quite the "head scratcher". This is one of those "lesions" that is difficult to recognize for those who are uninitiated, but is quite characteristic (i.e. an "Aunt Minnie").

Click here for the diagnosis...