Presentation
Headache, diplopia, nausea and right upper and lower limb weakness.
Patient Data
An ill defined diffuse infiltrative process involving the deep white matter of left cerebral hemisphere mainly the temporal, frontal and parietal lobes, internal and external capsules, thalamus, left cerebral peduncle and left hemipons and contralaterally it extends through the corpus callosum to the right forceps minor fibers. The lesion displays bright signal on T2 and FLAIR, iso intense signal on T1 with no significant contrast enhancement or diffusion restriction. Mass effect in form of subfalcine herniation causing right lateral ventricular dilatation and transependymal CSF leakage are noted as well.
Case Discussion
The clinical presentation and MRI findings are suggestive of Gliomatosis cerebri which carries a poor prognostic outcome. Pathology reveals WHO grade III lesion.
Importantly, whereas gliomatosis was previously considered a distinct entity, since the 2016 update to the WHO classification of CNS tumors it is now merely thought of as a growth pattern.
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