Recurrent petit mal seizures in Erdheim-Chester disease mimicking an intra-axial brain tumor: illustrative case

Caren M. Stuebe, Amanda V. Jenson, Tanner W. Lines, Ashley M. Holloman, Matthew D. Cykowski, Steve H. Fung, Ronald E. Fisher, Kenneth L. McClain, David S. Baskin

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


BACKGROUND Erdheim-Chester disease (ECD) is a rare non–Langerhans cell histiocytosis characterized histologically by foamy histiocytes and Touton giant cells in a background of fibrosis. Bone pain with long bone osteosclerosis is highly specific for ECD. Central nervous system involvement is rare, although dural, hypothalamic, cerebellar, brainstem, and sellar region involvement has been described. OBSERVATIONS A 59-year-old man with a history of ureteral obstruction, medically managed petit mal seizures, and a left temporal lesion followed with serial magnetic resonance imaging (MRI) presented with worsening seizure control. Repeat MRI identified bilateral amygdala region lesions. Gradual growth of the left temporal lesion over 1 year with increasing seizure frequency prompted resection. A non–Langerhans cell histiocytosis with a BRAF V600E mutation was identified on pathology. Imaging findings demonstrated retroperitoneal fibrosis and long bone osteosclerosis with increased fluorodeoxyglucose uptake that, together with the neuropathologic findings, were diagnostic of ECD. LESSONS This case of biopsy-proven ECD is unique in that the singular symptom was seizures well controlled with medical management in the presence of similarly located bilateral anterior mesial temporal lobe lesions. Although ECD is rare intracranially, its variable imaging presentation, including the potential to mimic seizure-associated medial temporal lobe tumors, emphasizes the need for a wide differential diagnosis.

Original languageEnglish (US)
Article numberCASE23248
JournalJournal of Neurosurgery: Case Lessons
Issue number16
StatePublished - Oct 16 2023


  • Erdheim-Chester disease
  • non-Langerhans cell histiocytosis
  • seizures

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery


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