Calcified Granulomatous Lesions of Brain
Whenever an inflammation occurs, the tissue affected respond producing an inflammatory exudate and a granuloma is formed. A granuloma in the brain is nothing but a localized area of inflammation.
This inflammation may be due to some infection, vascular problem, injury or any other trigger.
Products of inflammation are formed there. Inflammatory exudate along with WBC’S, pus cells, sloughed tissue debris etc. is present in the granuloma.
As a granuloma becomes old, it may calcify. Therefore, calcification of granulomas indicate that they have been there since a long time. This is a natural process.
This can be compared with scar formation, which is easily observed over the superficial wounds of our body. A fresh wound heals slowly to produce a harder covering over it. Under this cover, repair work takes place and new healthy cells are formed.
This is called scar formation, which is similar to calcification of a granuloma.
Possible Reasons of Brain Inflammations That May Lead to Granuloma Formation
- Trauma or injury to the brain
- Stroke or stroke-like episode, which may have caused reduced blood supply to that particular area of the brain. This may have led to infarction. Such a situation is common in people presenting with long standing high blood pressure.
- Infection of that brain area- encephalitis, meningitis etc. as seen in tuberculosis and other infectious diseases.
- Inflammations caused by autoimmune disorders like amyloidosis, rheumatoid disorders, multiple sclerosis etc.
- Any brain tumor
- In conditions like worm infestations like cysticercosis. The eggs of the worm may reach the brain and elicit an inflammatory response there.
Effects of a Granuloma
A granuloma is a space occupying lesion (SOL) in the brain tissue. It presses over the adjoining brain cells. This affects the functioning of those cells.
Depending upon the area of the brain where the granuloma is present, various brain functions may get affected. The affected individual may get severe headaches, nausea, fits (convulsions) or some focal deficit.
Focal deficits may include complete or partial loss of vision, impaired hearing, affected speech or any other body function.
A granuloma may be active or inactive ( also called dormant).
In an active one, inflammation is going on and fresh products of inflammation are being produced. Whereas, inactive granulomas are dormant, showing no activity on repeated CT scans. They are usually calcified and hard on appearance. They do not increase in size. Repeated CT’s may show shrinkage of such lesions.
Since a granuloma is a space occupying lesion in the brain, there are chances that it may press upon the adjoining tissues to produce symptoms.
Therefore, most of the patients presenting with this problem are given an anti-epileptic medication as a prophylaxis. Some patients may require pain medications for headaches or other symptoms they are facing.
The treatment is essentially controlling the symptoms, to start with.
Next step is assessing whether the granuloma is active or not. If active, cause of granuloma formation is investigated and this underlying cause is treated.
It is possible that the infection is still there and actively causing inflammation in the brain tissue. This may be a bacteria, virus or even a parasite. Accordingly, medicines are given to combat the infection.
Anti- inflammatory medicines are given to reduce inflammation and to prevent the granuloma from increasing in size.
Sometimes, if the location of the granuloma permits, surgical excision of the lesion may be done.
Inactive or dormant granulomas tend to shrink in size on their own. Except for symptomatic treatment, no medical intervention is required for them.