Bilateral and symmetric thalamic glioma

Case contributed by Bianca Larissa Pereira

Presentation

Female patient with mental confusion and behavioral change for 6 months.

Patient Data

Age: 65-70 years
Gender: Female

CT scan with contrast for stereotactic marking

CT

Slightly hyperdense bi-thalamic expansive lesion with mass effect on the lateral ventricles.

Large bilateral and the symmetrical expansive/infiltrative lesion in the thalamus and midbrain roof, with a hyperintense signal in T2 / FLAIR and intermediate in T1, determining compression in the contiguous portions of the supratentorial ventricular system, without conditioning aqueduct stenosis. There is small impregnation of nodular contrast in the posteromedial aspect of the left thalamic lesion and no diffusion restriction was seen.

Anaplastic astrocytoma ( World Health Organization grade III) was the result of the biopsy.

Case Discussion

The exam shows a bilateral and symmetric expansive/infiltrative thalamic mass, with a hyperintense signal in T2 / FLAIR, intermediate in T1 and no diffusion restriction or important impregnation of contrast, this findings with the symptoms strongly suggests the diagnosis of thalamic glioma.
Bilateral thalamic glioma is rare, with some cases described in the literature. The symptoms included personality change, confusion, memory loss, apathy, emotional lability, and dementia.
The histology type of bilateral thalamic glioma is variable with a predilection for low-grade astrocytoma ( World Health Organization grade II). This patient was diagnosed with anaplastic astrocytoma, as shown by the biopsy result.
As the prognosis of bilateral thalamic gliomas is poor and rapid fatal evolution has been observed in some other cases, the family opted for non-invasive treatment.

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