Abstract
BackgroundPrimary diffuse leptomeningeal gliomatosis (PDLG) is a lethal neoplasm that is characterized by glioma cells exclusively infiltrating into cerebral and spinal meninges. Intraventricular hemorrhage as an initial symptom in PDLG patient has not been reported in the literatures.Case presentationA 39-year-old man initially presented with intraventricular hemorrhage. The patient had an improved outcome at the early stage of hemorrhagic course; however, the clinical condition began to a sudden turn for deterioration with intracranial hypertension and cerebral hernia on day 15 after admission. Cerebral CT and MRI showed diffuse patchy signals with enhancement in bilateral cerebellopontine angle cistern, suprasellar cistern, ambient cistern, quadrigeminal cistern, bilateral cerebellum, cerebral hemisphere, and upper cervical cord surface. Pathological examination revealed that numerous spindled cells were scant of cytoplasm with hyperchromatic nuclei and various mitotic figures. Immunohistochemistry showed that the cells were positive to glial fibrillary acidic protein (GFAP) with about 5 % Ki-67 positive labeling. The pathological findings were consistent with the diagnostic criteria of anaplastic astrocytoma (WHO grade III).ConclusionWe reported an interesting case that PDLG initially presented with intraventricular hemorrhage that might be caused by astrocytoma rupturing into pial vessels.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-015-0341-1) contains supplementary material, which is available to authorized users.
Highlights
Primary diffuse leptomeningeal gliomatosis (PDLG) is a lethal neoplasm that is characterized by glioma cells exclusively infiltrating into cerebral and spinal meninges
We reported an interesting case that PDLG initially presented with intraventricular hemorrhage that might be caused by astrocytoma rupturing into pial vessels
We described a case of 39-year-old man initially presented with intraventricular hemorrhage, was diagnosed as PDLG associated with anaplastic astrocytoma
Summary
We described a case of primary diffuse leptomeningeal gliomatosis associated with anaplastic astrocytoma. It was an interesting case of PDLG initially presenting with intraventricular hemorrhage that might be caused by astrocytoma rupturing into pial vessels. Patient consent Written informed consent was obtained from the patient’s wife for publication of this case report and any accompanying images. Competing interests The authors declare that they have no competing interests. Authors’ contributions Dr ZM drafts the manuscript; Dr ZJ and Dr ZY collect the clinical data, the radiological images, and pathological data. Professor WH and Professor WY guided the research and gave the important clinical opinions. All authors read and approved the final manuscript
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