A rare case of gliomatosis cerebri lurking beneath the shadows of a stroke mimic.
A rare case of gliomatosis cerebri lurking beneath the shadows of a stroke mimic.
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DOI：
10.1016/j.radcr.2021.06.060
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发表时间：
2021-09
影响因子：
--
通讯作者：
Sriwastava S
中科院分区：
文献类型：
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作者：
Prasad A;Hurlburt G;Van Antwerp E;Srivastava S;Sriwastava S
脑胶质瘤病（GC）是一种弥漫性浸润性肿瘤胶质过程，预后不良。考虑到其罕见性、不可预测的临床表现和缺乏特征性的影像学特征，胃癌是一种难以诊断的疾病，常常被延误。在这个报告中，我们提出了一个61岁的男性慢性酒精滥用和心房颤动的历史，谁提出右臂无力最初被认为是急性缺血性中风。直到出现初始症状6个月后才诊断出GC，并在考虑神经认知表现和暗示性影像学表现时进行诊断。在我们的病例中，皮质、胼胝体和幕下结构中出现快速、扩张性病变，伴有轻度实质肿大，更能揭示典型GC的侵袭性实体，而不是缺血性过程和其他病理。这个病例显示了其迅速识别的致命挑战，以及在诊断时出现晚期症状的患者的治疗局限性。在具有如此快速的多叶临床特征且影像学上具有相似的弥漫性侵袭性生长模式的病例中识别GC可以避免诊断延误并提高患者的生活质量。
Gliomatosis cerebri (GC) is a diffuse infiltrative neoplastic glial process with a devastating prognosis. Considering its rarity, unpredictable clinical manifestations, and lack of characteristic radiographic features, GC is a difficult diagnosis that is quite often delayed. In this report, we present a case of a 61-year-old man with a history of chronic alcohol abuse and atrial fibrillation who presented with right arm weakness initially presumed to be from an acute ischemic stroke. GC was not diagnosed until six months after initial symptoms and diagnosis was indicated when considering the neurocognitive findings in conjunction with suggestive radiographic findings. The presence of a rapid, expansile lesion in the cortex, corpus callosum, and infratentorial structures with mild parenchymal enlargement, as shown in our case, is more revealing of an invasive entity typical of GC rather than an ischemic process and other pathologies. This case demonstrates the fatal challenges of its prompt recognition and the therapeutic limitations for those patients presenting with advanced symptoms at the time of diagnosis. Recognizing GC in cases with such rapid multilobe clinical features with similar diffusely invasive patterns of growth on imaging can avoid a delay in diagnosis and improve patient quality of life.