Abstract
Gliomatosis cerebri (GC) is a rare astrocytic tumor that typically affects multiple lobes of the brain. Due to its insidious nature and atypical symptom presentation, diagnosis is often made late in the course of disease process. To date, no definitive treatment guidelines have been established, and due to its infiltrating pattern, neurosurgical resection of the lesion is generally not feasible. We report a case of a 69-year-old male who initially presented with symptoms similar to normal pressure hydrocephalus. The patient underwent CSF diversion, with an inconclusive tissue biopsy. His symptoms were relieved for more than two years thereafter until he demonstrated worsening of symptoms, with a MRI clearly demonstrating GC. Patients presenting with hydrocephalus and a full posterior fossa should be followed carefully for evidence of GC progression.
Highlights
Gliomatosis cerebri (GC) is an uncommon tumor of the central nervous system, which histologically resembles a diffuse cerebral infiltration by glial neoplasm without formation of a solid tumor mass and preserves the architecture of the tissue surrounding the tumor [1]
Radiotherapy and adjuvant chemotherapy with various agents have been suggested for disease control, and recently, positive treatment responses were demonstrated in published literature [4]
Exhibited symptoms at the time of initial presentation were unspecific and were demonstrative more of normal pressure hydrocephalus, which delayed the final diagnosis. This case demonstrates that, in an elderly patient who presents with gait instability and evidence of a diffuse unspecific lesion within the posterior fossa, he/she must be followed carefully for evolution of symptomatology for evidence of occult development of pathology, such as gliomatosis cerebri
Summary
Gliomatosis cerebri (GC) is an uncommon tumor of the central nervous system, which histologically resembles a diffuse cerebral infiltration by glial neoplasm without formation of a solid tumor mass and preserves the architecture of the tissue surrounding the tumor [1]. Exhibited symptoms at the time of initial presentation were unspecific and were demonstrative more of normal pressure hydrocephalus, which delayed the final diagnosis. This case demonstrates that, in an elderly patient who presents with gait instability and evidence of a diffuse unspecific lesion within the posterior fossa, he/she must be followed carefully for evolution of symptomatology for evidence of occult development of pathology, such as gliomatosis cerebri. Follow-up imaging studies performed 6, 12 (Figure 2), and 18 months from the initial ones demonstrated decrease in ventricular size with stable T2/FLAIR changes in the brainstem and cerebellum without any evidence of evolving pathology.
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