Presentation
Confusion with a headache.
Patient Data
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There are bilateral asymmetrical thalamic, left basal ganglia and left side of midbrain lesions showing low signal intensity on T1WI high signal intensity on FLAIR and T2WI without surrounding perilesional edema, causing mild shifting of midline structures to the right side.
The 3rd ventricle is compressed by the masses with subependymal edema, indicating active hydrocephalus.
No enhancement following IV contrast.
No restricted diffusion.
Normal opacification of all dual venous sinuses.
Case Discussion
Bilateral non-enhancing asymmetrical thalami masses resulting in obstructive active hydrocephalus features highly suggestive of bilateral thalamic gliomas.
Infection is excluded by the clinical picture, the mass effect and no post-contrast enhancement.
Vascular (ischemic venous infarction) is excluded by normal opacification of dural sinuses post-contrast and no restriction diffusion.
The patient was transferred to an oncology center in another hospital, where she was started on chemo and radiotherapy without undergoing a biopsy. Follow up images (not shown) didn't show significant changes.
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