BRAIN BIOPSY IN CRYPTOGENIC NEUROLOGIC DISEASE

Objective Brain biopsy is an established procedure for the histological diagnosis of malignancy but its diagnostic role in cryptogenic neurological disease is less clear. This service evaluation reviews the procedure in a single centre (University Hospital Birmingham, UHB) by assessing indications, outcomes and complications in patients with neurological disease of uncertain aetiology. Methods We retrospectively identified patients referred for brain biopsy by neurology from 2005 to 2015. 19 patients were identified although 5 were excluded due to destroyed or missing notes. Results Histological report was definitive (n=8) or suggestive (n=2) in 10 of the 14 patients (71%) and non-diagnostic in 4 others (29%). The most common diagnosis was lymphoma in 3 patients (21.4%). Brain biopsy altered management in 64% (9/14) of patients. Importantly, there were no deaths or haemorrhage reported, and only 2 patients with documented headache reported after the procedure. Direct communication with neuropathology was documented in 1 case. Conclusions Few biopsies were undertaken for cryptogenic neurological disease in this time period, amounting to approximately 2 cases per year in our centre. However, management was changed in up to two-thirds of cases with no significant complications. Thus, brain biopsy is both safe and helpful in managing difficult neurological cases.