Elsevier

Magnetic Resonance Imaging

Volume 24, Issue 2, February 2006, Pages 205-207
Magnetic Resonance Imaging

Case report
Magnetic resonance spectroscopy: a noninvasive diagnosis of gliomatosis cerebri

https://doi.org/10.1016/j.mri.2005.10.032Get rights and content

Abstract

Gliomatosis cerebri (GC) is characterized by a diffuse infiltration of neoplastic glial cells with preservation of neuronal architecture. It can be very difficult to diagnose during life because the clinical manifestations are protean and tests are often nondiagnostic. The diagnosis of GC needs to be based on radiological, clinical and pathological criteria. We present a patient with GC, which initially presented as acute stroke attack. We discuss the usefulness of noninvasive methods, such a MR spectroscopy, in the diagnosis, grading and management of GC.

Introduction

Gliomatosis cerebri (GC) is a rare primary brain tumor of unknown origin characterized by the proliferation of neoplastic glial cells, and this process may involve multiple brain regions [1], [2], [3], [4]. It can be very difficult to diagnose during life because the clinical manifestations are protean and tests are often nondiagnostic [5], [6]. The diagnosis of GC needs to be based on radiological, clinical and pathological criteria [7], [8]. Magnetic resonance imaging (MRI) has become the radiological method of choice in the diagnosis of GC [9]. Conventional MRI shows a diffuse signal intensity abnormality in T2-weighted and fluid-attenuated inversion recovery images with minimal or no mass effect and a lack of contrast enhancement. Magnetic resonance spectroscopy (MRS), which may be added to conventional MRI exam, provides a noninvasive biochemical assay of normal and pathological brain tissue and may help narrow the differential diagnosis in favor of a neoplastic lesion by revealing increased Cho/Cr and Cho/NA and variably decreased NA/Cr [10], [11].

We present a patient with GC, which initially presented as acute stroke attack. We discuss the usefulness of noninvasive methods, such MR spectroscopy, in the diagnosis, grading and management of GC.

Section snippets

Case report

A 59-year-old female patient presented with acute onset of dizziness, nausea, confusion and olfactory hallucinations. She had a history of pulmonary embolism and had been treated with anticoagulant drugs. There were no complaints of cognitive or behavioral impairments. The clinical examination revealed decreased level of consciousness and confusion. The motor strength was normal, and no sensory deficits were detected. Babinski sign was negative. With these findings and the acute onset of

Discussion

Gliomatosis cerebri is characterized by a diffuse infiltration of neoplastic glial cells with preservation of neuronal architecture. It was first described in a case report by Nevin [13] in 1938 as a glial neoplasm with diffuse infiltration throughout the brain yet with relative preservation of underlying neuronal architecture.

In the latest WHO classification GC is listed as a subgroup of neuroepithelial tumors of uncertain origin with involvement of at least two lobes without a cellular,

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