Presentation
Difficulty in walking and weakness in all limbs.
Patient Data
Multiple altered signal lesions are seen in the right anterior temporal cortex, right thalamus, bilateral cerebellar vermis region, right middle cerebellar peduncle, left frontal periventricular region. Associated coerical thickening with edema noted. The lesions shows variable enhancement form predominantly non-enhancemt with few lesions show ring and nodular enhancement. The largest enhancing lesions measuring approx 2.2 x 1.7 cm at cerebellar vermis, 1.1 x 1.2 cm at right thalamus, 1.0 x 1.1 cm at right anterior temporal region. The lesion at the right thalamus shows ring enhancement. There is moderate perileasional edema seen at both thalamus, right temporal region and cerebellar region bilaterally.
Case Discussion
These findings most likely represents diffuse gliomatosis cerebri.
Other unlikely differential is demyelinating disease / ADEM.
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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