INTRODUCTION Granulomatous inflammation is a distinctive ...

(Table 5). Cholesteatomas arise in similar regions as cholesterol granulomas and are usually
contained within the tympanomastoid region but aggressive lesions do occur with erosion of bone
(Topalogue et al 1997).
CT scan, in both cholesteatomas and cholesterol granulomas, shows a non-specific, non-enhancing
soft tissue mass that has a smooth margin and variable bone erosion (Chang et al., 1998). By MRI,
cholesteatomas are hypointense or isointense on T1-weighted images and hyperintense on T2
images. Cholesterol granulomas typically are homogenous and show bright signal intensity on
both T1- and T2-weighted images without significant enhancement with gadolinium contrast
(lustig et al., 1998). When large, however, cholesterol granulomas can exhibit a more
heterogeneous MRI pattern (Martin et al., 1989).
Table 5. Points of difference between Cholesterol Granulomas and Cholesteatoma (Topalogue et
al 1997)
It is important to make the distinction between cholesterol granuloma and cholesteatoma because
of treatment differences. Cholesterol granulomas will resolve after internal drainage into the
mastoid cavity or middle ear, relieving the obstruction and restoration of the normal
pneumatization of the bone . However, there have been reports of large destructive cholesterol
granulomas that require complete surgical excision (Lustig et al., 1998).
DISCUSSION
The granulomatous disorders involving the CNS are a diverse confusing medical problem. They
are assumed to be multifactor difficulties regarding clinical picture, poor investigational yield,
some have controversial treatment and many of them are difficult to be cured if not fatal. The
hallmark for these difficulties is the diverse non specific systemic and neurological clinical
presentations for such patients to the extent that many medical specialties face these patients
separately on the first time, and unless the physicians have a high index of clinical suspicion to
such non specific clinical presentations, there will be subsequent delay in diagnosis with
deterioration of clinical picture making the management of poor outcome.
Furthermore, each of these diseases has its own diagnostic workup on one hand and most of the