Bilateral thalamic gliomata
30 years old male patient, who presents a rapid deterioration of consciousness.
ASNR 2016: This case was submitted as part of the American Society of Neuroradiology (ASNR 2016) Case Of The Day competition, in collaboration with Radiopaedia.org.
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Brain MRI demonstrates bilateral thalamic mass, predominant on the right thalmus, showing a high signal on T2 and FLAIR, an important mass effect on adjacent structures.
Echo Gradient T2 shows no calcifications or bleeding within the mass.
No enhancement is noted after Gadolinium Chelate intra venous administration, rCBV is at 1.2
MRS demonstrates elevation of the choline - creatine and Choline - NAA ratios and persistance of myo-inositol spike.
A NECT (not shown) demonstrates a bi-thalamic mass, responsible for a noncommunicating bilateral hydrocephalus by compression of the third ventricule. A ventriculo-perotoneal shunt is performed. The patient wakes up with left hemiplegia, aphasia, deglutation and respiratory disorders of central origin.
Brain MRI demonstrates bilateral thalamic mass, predominant on the right thalmus, which would rather be the reason why the patient had a left sided hemiplegia. Morphological aspect, Perfusion profile and MRS are consistent with a low grade bilateral thalamic glioma.