The diagnostic utility of brain biopsy procedures in patients with rapidly deteriorating neurological conditions or dementia

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Object

Obtaining brain biopsy specimens is often the diagnostic test of last resort for patients with unexplained neurological conditions, particularly those with a rapidly deteriorating neurological course. The goals of this analysis were to determine the diagnostic sensitivity of brain biopsy specimens in these types of patients and retrospectively identify features of these disorders that may have enabled an earlier diagnosis, which may prevent the need for diagnostic brain biopsy procedures in the future.

Methods

The authors reviewed the case records of all brain biopsy procedures that had been performed at a single tertiary care institution between January 1993 and April 2002 in 171 patients. Patients with HIV or nonlymphomatous brain tumors were excluded from this analysis because the utility of brain biopsy specimens for these conditions has been determined from previous studies. A subgroup analysis of this cohort was performed in the 64 patients who had comprehensive medical records and a clinical syndrome involving a progressively deteriorating neurological condition of less than 1 year in duration.

The overall sensitivity of brain biopsy procedures for diagnostic purposes in the cohort was 65% (111 of 171 patients). The two most common diagnoses in the subgroup with rapidly deteriorating neurological conditions were primary central nervous system (CNS) B-cell lymphoma in 20.3% (13 patients) and Creutzfeldt–Jakob disease in 15.6% (10 patients), followed by viral encephalitis in 14.1% (nine patients) and CNS vasculitis in 9.4% (six patients). Clinical symptoms and laboratory data were compared among the diagnostic groups.

Conclusions

These results will help guide the evaluation of patients with neurological conditions that are difficult to diagnose and will provide a foundation for further prospective studies.

Abbreviations used in this paper:

CJD = Creutzfeldt–Jakob disease; CNS = central nervous system; CSF = cerebrospinal fluid; ESR = erythrocyte sedimentation rate; PCNSL = primary central nervous system lymphoma; PCR = polymerase chain reaction; WBC = white blood cell.

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  • 1

    Fishman RA: Cerebrospinal Fluid in Diseases of the Nervous System, ed 2 Philadelphia, PA, WB Saunders, 1992. p 339

  • 2

    Hall WA: The safety and efficacy of stereotactic biopsy for intracranial lesions. Cancer 82:17491755, 1998

  • 3

    Hellmann D, , Roubenoff R, , Healy RA, & Wang H: Central nervous system angiography: safety and predictors of a positive result in 125 consecutive patients evaluated for possible vasculitis. J Rheumatol 19:568572, 1992

    • Search Google Scholar
    • Export Citation
  • 4

    Hulette CM, , Earl NL, & Crain BJ: Evaluation of cerebral biopsies for the diagnosis of dementia. Arch Neurol 49:2831, 1992

  • 5

    Javedan SP, & Tamargo RJ: Diagnostic yield of brain biopsy in neurodegenerative disorders. Neurosurgery 41:823830, 1997

  • 6

    Kaufman HH, & Catalano LW Jr: Diagnostic brain biopsy: a series of 50 cases and a review. Neurosurgery 4:129136, 1979

  • 7

    Moore PM: Diagnosis and management of isolated angiitis of the central nervous system. Neurology 39:167173, 1989

  • 8

    Peretz D, , Supattapone S, , Giles K, , Vergara J, , Freyman Y, & Lessard P, et al.: Inactivation of prions by acidic sodium dodecyl sulfate. J Virol 80:322331, 2006

    • Search Google Scholar
    • Export Citation
  • 9

    Sevush S, & Turkewitz LJ: Brain biopsy: risks, benefits, and indications. Mt Sinai J Med 52:380383, 1985

  • 10

    Shiga Y, , Miyazawa K, , Sato S, , Fukushima R, , Shibuya S, & Sato Y, et al.: Diffusion-weighted MRI abnormalities as an early diagnostic marker for Creutzfeldt-Jakob disease. Neurology 63:443449, 2004

    • Search Google Scholar
    • Export Citation
  • 11

    Young GS, , Geschwind MD, , Fischbein NJ, , Martindale JL, , Henry RG, & Liu S, et al.: Diffusion-weighted and fluid-attenuated inversion recovery imaging in Creutzfeldt-Jakob disease: high sensitivity and specificity for diagnosis. AJNR Am J Neuroradiol 26:15511562, 2005

    • Search Google Scholar
    • Export Citation
  • 12

    Zerr I, , Pocchiari M, , Collins S, , Brandel JP, , de Pedro Cuesta J, & Knight RSG, et al.: Analysis of EEG and CSF 14–3–3 proteins as aids to the diagnosis of Creutzfeldt-Jakob disease. Neurology 55:811815, 2000

    • Search Google Scholar
    • Export Citation

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