New-onset headache in a Wegener’s granulomatosis patient

By Yosef Laviv, MD*, Harsha Gopal, MD**  and Ekkehard Kasper,1 MD PhD*

*Department of Surgery, Division of Neurosurgery / ** Division of Ear, Nose and Throat Surgery
Beth Israel Deaconess Medical Center, Harvard Medical School; Boston, MA USA
A 59-year-old male presented with new onset headaches (HA), lasting longer than 24 hours and localized to the frontal area. He also had nasal congestion. The patient denied any visual problems, N/V or any other neurological symptoms. His past medical history included HTN and Wegener’s granulomatosis. He has also had a traumatic head injury 4 years earlier with two small brain hemorrhages. His list of medications included methotrexate, prednisone (both for Wegener’s disease), Lisinopril and Ritalin. The patient was referred to the ED. His vital signs, physical and neurological examinations were within normal limits. A non-contrast head CT was obtained (Figure 1).

Figure 1: Head CT showing an anterior midline, hypodense cystic mass. The mass displayed a calcified posterior rim (arrow). A: axial; B: sagittal; C: coronal (bone window).

* 1. What is the diagnosis? How can you support it? What are the possible etiologies in this patient?