Abstract
Primary diffuse leptomeningeal gliomatosis (PDLG) is a rare and fatal disease with no special clinical manifestations. Here, we report the dynamic brain magnetic resonance imaging (MRI) changes in a 30-year-old female PDLG patient over a 10-month period. MRI showed aggressive dilation of the subarachnoid space and the ventricular system, numerous encapsulated cysts in the subarachnoid space and the dilated cerebral sulci, diffuse reticulated or focal nodular enhancement in the subarachnoid space, as well as overall enhancement in the cystic walls. In addition to the aforementioned PDLG pathological findings, MRI also revealed non-contrasted solid lesions and a contrasted cyst-like lesion in the paraventricular areas. The dynamic and multiform neuroradiological changes help us to understand the pathological process of PDLG. Of particular interest is the discovery that parenchymal infiltration can occur in PDLG.
Highlights
Primary diffuse leptomeningeal gliomatosis (PDLG) is associated with rapid disease progression and mortality
Diffuse enhancement was noticed in the meninges, the left thalamus adjacent ventricular ependyma, the cerebellar tentorium, and the quadrigeminal cistern, whereas no enhancement was identified in the parenchyma (Figures 1B,C)
The brain magnetic resonance imaging (MRI) at this time revealed a round mass in the quadrigeminal cistern, multiple cyst signals in the Sylvian fissures, and the dilated cortical sulci in addition to the lesion in left thalamus
Summary
Primary diffuse leptomeningeal gliomatosis (PDLG) is associated with rapid disease progression and mortality. PDLG arises from heterotopic neuroglia tissue in the leptomeninges and spreads widely throughout the subarachnoid space [1]. The majority of these neoplasms are often high grade astrocytic [2] and few are oligodendrogliomatosis [3]. Compared with oligodendrogliomatosis [3, 4], the astrocyte-derived PDLG is more aggressive. PDLG is confined to the leptomeninges without involvement of the brain or the spinal cord [1]. We report serial magnetic resonance imaging (MRI) findings from a PDLG patient over a 10-month period. Dynamic alterations in the brain MRI findings over time help elucidate the natural history of PDLG
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