Glioblastoma NOS spreading to the corticospinal tract

Case contributed by Nick Tarasov
Diagnosis probable

Presentation

2 months of the left sided hemiparesis treated as a stroke.

Patient Data

Age: 50 years
Gender: Male
This study is a stack
Axial
T2
This study is a stack
Axial
T1 C+
This study is a stack
Axial
DWI
This study is a stack
Axial
ADC
This study is a stack
Sagittal
T1
This study is a stack
Sagittal
T1 C+
This study is a stack
Coronal
T1 C+
This study is a stack
Axial MR
Perfusion (CBV)
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Info

Irregularly shaped mass involving both right pre/postcentral gyri with inhomogeneous inner architecture.

Mild vasogenic oedema, mild mass effect to the right ventricle.

Vivid enhancement elevated CBV and CBF and diffusion restriction of the solid component.

The right proximal portion of corticospinal tract fibres involved, best seen on the post contrast coronal images, at the level of tentorium cerebelli.

Case Discussion

This case well demonstrates how glioma cells can migrate along myelinated white matter tracts and also shows an important role of MRI examination among patients with a possible stroke signs.

A primary brain tumour is one of the several clinical presentations for a 'stroke mimic'.

Note: As this case does not provide a histological diagnosis of IDH mutation status, according to the current (2016) revision WHO classification of CNS tumours this tumour would be classified as a probable glioblastoma NOS.

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