Elsevier

Journal of Clinical Neuroscience

Volume 71, January 2020, Pages 293-295
Journal of Clinical Neuroscience

Case report
An atypical presentation of diffuse midline pontine glioma in a middle age patient: Case report

https://doi.org/10.1016/j.jocn.2019.08.096Get rights and content

Highlights

  • Diffuse midline glioma is a newly entity reported in pediatric population and occasionally in young adults.

  • We present a case of midline pontine glioma in a middle aged woman, with atypical imaging and biochemical features.

  • We suggest to perform biopsy at early stage of atypical brainstem lesion.

Abstract

Introduction

Diffuse midline glioma is a newly WHO defined entity (grade IV) (Louis et al., 2016) which includes diffuse intrinsic pontine glioma (DIPG) reported in pediatric population and, occasionally, in young adults.

Here, we present a detailed description of an atypical case of diffuse midline glioma in a 53 years old woman.

Case report

A caucasian woman aged 53 from Ukraine, was referred to another neurological department complaining of 3 months history of progressive postural instability and gait impairment with frequent falling. Magnetic resonance demonstrated two brainstem lesions, hyperintense in FLAIR with “patchy” peripheral enhancement, leptomeningeal and cranial nerves enhancement. CSF was normal. Due to positive antinuclear antibodies test (ANA 1:360), intravenous steroid treatment was administered and reported to initially improve the patient condition. However, the following weeks the lady worsened. Imaging features were unchanged. Because quantiferon test resulted positive, MRI-Spectroscopy showed an inflammatory pattern and MRI perfusion study and brain FDG-PET, were normal, tubercolar granulomatous hypothesis was initially favored. Antitubercular therapy with isoniazid, pyrazinamide, ethambutol and rifampicin was started without any clinical improvement. Hence, the biopsy was proposed. The procedure revealed a diffuse midline pontine glioma. Considering the advanced stage of the disease, radiotherapy was not indicated. Patient died after eight months from the onset of neurological disturbances.

Conclusion

Our case shows that diffuse midline glioma is a CNS tumor not limited to young population but occurring also in middle aged patients with an insidious pattern. We therefore recommend to perform biopsy at very early stages in patients with atypical brainstem lesions.

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