A woman in her late 50s presented with decreased visual acuity and headache. She had a low-grade fever, episcleritis, and a mild left-sided pronator drift. Imaging revealed a right-sided subdural collection, temporal lobe edema, and enhancing leptomeninges (Figure 1A-C). Further workup revealed pulmonary and nasal cavitary lesions on computed tomography. Diagnosis of granulomatosis with polyangiitis (GPA), formerly known as Wegener granulomatosis, was confirmed serologically (antineutrophil cytoplasmic antibody, proteinase 3) and histopathologically via biopsy of her nasal and pulmonary lesions (Figure 1D). Her symptoms, including pyramidal weakness, subsided by the third day of treatment with pulsed steroids. Repeated imaging demonstrated complete resolution of the collection (Figure 2).
Naif M. Alotaibi, George M. Ibrahim, Hamza Jalal, Bayardo Perez-Ordonez, Mojgan Hodaie, Suneil K. Kalia. Subdural Collection as Initial Presentation of Granulomatosis With Polyangiitis. JAMA Neurol. 2016;73(5):602–603. doi:10.1001/jamaneurol.2015.4710