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Contemporary outcomes of diffuse leptomeningeal glioneuronal tumor in pediatric patients: A case series and literature review. Clin Neurol Neurosurg 2022; 218:107265. [DOI: 10.1016/j.clineuro.2022.107265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/09/2022] [Accepted: 04/22/2022] [Indexed: 01/04/2023]
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2
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Gatzert S, Durgam A, Raghuram K, Agarwal A. Primary diffuse leptomeningeal oligodendrogliomatosis with an isolated 1p deletion. Br J Neurosurg 2019:1-6. [PMID: 31752539 DOI: 10.1080/02688697.2019.1688253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We report a case of primary diffuse leptomeningeal oligodendrogliomatosis with an isolated 1p deletion confirmed by fluorescent in situ hybridization (FISH) analysis in 52 year-old man. The MRI scan in a patient presenting with progressive headache, nausea and diplopia revealed diffuse leptomeningeal thickening and enhancement without definitive evidence of an intraparenchymal lesion. Biopsy of thickened, enhancing meninges within the left sylvian fissure revealed subarachnoid proliferation of oligodendroglial cells with varying degrees of de-differentiation and sparing of the underlying cortex. An isolated 1p deletion was confirmed by FISH analysis. This is the first reported adult case of a 1p deletion in primary diffuse leptomeningeal oligodendrogliomatosis.
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Affiliation(s)
- Samuel Gatzert
- Department of Radiology, UT Southwestern Medical School, Dallas, TX, USA
| | - Aditya Durgam
- Department of Radiology, UT Southwestern Medical School, Dallas, TX, USA
| | | | - Amit Agarwal
- Department of Radiology, UT Southwestern Medical School, Dallas, TX, USA
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Chellathurai A, Vaidya JS, Kathirvelu G, Alagappan P. Primary diffuse leptomeningeal oligodendrogliomatosis: A case report and literature review. Indian J Radiol Imaging 2016; 26:337-341. [PMID: 27857459 PMCID: PMC5036331 DOI: 10.4103/0971-3026.190424] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Primary leptomeningeal oligodendrogliomatosis (PLO) is a rare low-grade intracranial and spinal canal subarachnoid neoplasm without an obvious primary neoplasm in the brain or spinal cord parenchyma. We present here the serial progression of radiological findings of this rare disease in a 2-year-old male child whose clinical status deteriorated over a period of 4 months with the main complaint of partial seizures. During this period, the MR findings progressed from mild hydrocephalus with minimal leptomeningeal enhancement to leptomeningeal multiple cystic lesions in the entire neuraxis including the spine.
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Affiliation(s)
- Amarnath Chellathurai
- Department of Radiodiagnosis, Government Stanley Medical College, Chennai, Tamil Nadu, India
| | - Jay S Vaidya
- Department of Radiodiagnosis, Government Stanley Medical College, Chennai, Tamil Nadu, India
| | | | - Periakaruppan Alagappan
- Department of Radiodiagnosis, Tamil Nadu Multispeciality Hospital, Omandurar, Chennai, Tamil Nadu, India
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Neuro-Ophthalmological Features of Primary Diffuse Leptomeningeal Gliomatosis. J Neuroophthalmol 2011; 31:299-305. [DOI: 10.1097/wno.0b013e31821ee5c2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Dörner L, Fritsch MJ, Hugo HH, Mehdorn HM. Primary diffuse leptomeningeal gliomatosis in a 2-year-old girl. ACTA ACUST UNITED AC 2009; 71:713-9, discussion 719. [DOI: 10.1016/j.surneu.2008.01.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Accepted: 01/06/2008] [Indexed: 11/29/2022]
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De Tommasi A, Occhiogrosso G, De Tommasi C, Luzzi S, Cimmino A, Ciappetta P. A polycystic variant of a primary intracranial leptomeningeal astrocytoma: case report and literature review. World J Surg Oncol 2007; 5:72. [PMID: 17587463 PMCID: PMC1934909 DOI: 10.1186/1477-7819-5-72] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2007] [Accepted: 06/23/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary leptomeningeal astrocytomas are rare intracranial tumors. These tumors are believed to originate from cellular nests which migrate by means of aberration, ultimately settling in the leptomeningeal structure. They may occur in both solitary and diffuse forms. The literature reports only fifteen cases of solitary primary intracranial leptomeningeal astrocytomas. CASE PRESENTATION The authors report the case of a seventy-eight year-old woman with a polycystic variant of a solitary primary intracranial leptomeningeal astrocytoma. The first neurological signs were seizures and aphasia. CT and MRI scans demonstrated a fronto-parietal polycystic tumor adherent to the sub arachnoid space. A left fronto-temporo-parietal craniotomy revealed a tight coalescence between the tumor and the arachnoid layer which appeared to wrap the mass entirely. Removal of the deeper solid part of the tumor resulted difficult due to the presence of both a high vascularity and a tight adherence between the tumor and the ventricular wall. CONCLUSION A new case of a solitary primitive intracranial leptomeningeal astrocytoma of a rare polycystic variant is reported. Clinical, surgical, pathologic and therapeutic aspects of this tumor are discussed.
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Affiliation(s)
- Antonio De Tommasi
- Department of Neurology and Neuropsychiatry Sciences, Chair of Neurosurgery, University of Bari, 70124 Bari, Italy
| | - Giuseppe Occhiogrosso
- Department of Neurology and Neuropsychiatry Sciences, Chair of Neurosurgery, University of Bari, 70124 Bari, Italy
| | - Claudio De Tommasi
- Department of Neurology and Neuropsychiatry Sciences, Chair of Neurosurgery, University of Bari, 70124 Bari, Italy
| | - Sabino Luzzi
- Department of Neurology and Neuropsychiatry Sciences, Chair of Neurosurgery, University of Bari, 70124 Bari, Italy
| | - Antonella Cimmino
- Department of Anatomical and Cellular Pathology, Chair of Pathology, University of Bari, 70124 Bari, Italy
| | - Pasqualino Ciappetta
- Department of Neurology and Neuropsychiatry Sciences, Chair of Neurosurgery, University of Bari, 70124 Bari, Italy
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Yomo S, Tada T, Hirayama S, Tachibana N, Otani M, Tanaka Y, Hongo K. A case report and review of the literature. J Neurooncol 2006; 81:209-16. [PMID: 17031563 DOI: 10.1007/s11060-006-9219-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Accepted: 07/10/2006] [Indexed: 11/27/2022]
Abstract
Primary diffuse leptomeningeal gliomatosis (PDLG) is a rare central nervous system neoplasm in which gliomatous tissue is diffusely identified in the subarachnoid space with no evidence of a primary intraparenchymal tumor. A 52-year-old man presented low back pain followed by sudden unconsciousness and had also cognitive dysfunction and meningeal sign. Examinations of cerebrospinal fluid (CSF) did not show malignant cells but increased protein and pleocytosis. Magnetic resonance (MR) imaging demonstrated diffuse leptomeningeal enhancement without any source of intraparenchymal lesion. Fluid-attenuated inversion recovery (FLAIR) also demonstrated individual diffuse high intensity area in the subarachnoid space. A biopsy disclosed wide spreading of anaplastic glial cells within the leptomeninges. He died 3 months later because of disease progression despite both radiotherapy and chemotherapy. Post-mortem examination identified PDLG and several neuropathological features of glioblastoma as well. Reviewing previous cases of PDLG instructs that this entity is rare, resembles meningitis in clinical pictures, usually occurs in a relatively younger population and has more progressive clinical course than the ordinary form of malignant gliomas.
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Affiliation(s)
- Shoji Yomo
- Department of Neurosurgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
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Debono B, Derrey S, Rabehenoina C, Proust F, Freger P, Laquerrière A. Primary diffuse multinodular leptomeningeal gliomatosis: case report and review of the literature. ACTA ACUST UNITED AC 2006; 65:273-82; discussion 282. [PMID: 16488248 DOI: 10.1016/j.surneu.2005.06.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2005] [Accepted: 06/15/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Primary diffuse leptomeningeal gliomatosis is an exceptional neoplasm, and only 30 cases have been reported in the literature. We report a recent case and compare data with previously published observations. METHODS A 50-year-old man was admitted to the neurosurgery department for a previous 4-month history of headache, associated with nonspecific neurological signs. Biologic data and cerebrospinal fluid examination suggested an inflammatory process. The patient was given an antituberculous therapy. Magnetic resonance imaging revealed a multinodular enhancement of spinal nerve roots. A biopsy of sacral rootlets was performed. Histological examination revealed an anaplastic astrocytoma. Patient's status worsened, and death occurred 7 months later. RESULTS Complete neuraxis postmortem examination revealed no intraparenchymatous glioma and was conclusive for the diagnosis of primary leptomeningeal gliomatosis (astrocytic, World Health Organization grade III), with a multinodular pattern in the spinal cord, the brainstem, and the brain base with diffuse extension into the cerebellar subarachnoid spaces. CONCLUSIONS Our case illustrates the diagnostic difficulties in making the premortem diagnosis. The review of the literature indicates that there are no specific clinical or biologic signs. Magnetic resonance imaging using T1-weighted images with gadolinium enhancement and biopsy material may be useful diagnostic tools. In most cases, autopsy evaluation alone permits definitive primary diffuse leptomeningeal gliomatosis diagnosis. Whatever the histological characteristics of proliferating cells are, the prognosis remains poor. No prognostic factors have been shown to be correlated with survival time. Unfortunately, no routine treatment has been yet proposed.
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Affiliation(s)
- Bertrand Debono
- Department of Neurosurgery, Rouen University Hospital-Charles Nicolle, 76031 Rouen Cedex, France.
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Bohner G, Masuhr F, Distl R, Katchanov J, Klingebiel R, Zschenderlein R, von Deimling A, van Landeghem FKH. Pilocytic astrocytoma presenting as primary diffuse leptomeningeal gliomatosis: report of a unique case and review of the literature. Acta Neuropathol 2005; 110:306-11. [PMID: 16003541 DOI: 10.1007/s00401-005-1051-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Revised: 05/20/2005] [Accepted: 05/20/2005] [Indexed: 10/25/2022]
Abstract
We describe a 25-year-old male patient with primary diffuse leptomeningeal gliomatosis (PDLG) presenting with gait ataxia, positive Lhermitte's sign, double vision, and right abducens nerve palsy. Spinal magnetic resonance imaging showed extended intradural, extramedullary, contrast-enhancing masses with compression of the myelon. Spinal leptomeningeal biopsy revealed a pilocytic astrocytoma WHO grade I. Despite chemotherapy with vincristin and carboplatin, the patient died 2 months after admission. A thorough autopsy showed no evidence for primary neoplasms in brain, spine and optic nerve. Sequence analysis of tumor protein 53 gene (TP53) revealed a missense mutation in exon 5, and expression of phosphatase and tensin homolog (mutated in multiple advanced cancers 1) (PTEN) protein was not detected, which may have contributed to astrocytoma development. To our knowledge, this is the first definitive case of pilocytic astrocytoma presenting as PDLG.
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Affiliation(s)
- Georg Bohner
- Department of Radiology, Neuroradiology Section, Charité Medical Center, 13344, Berlin, Germany
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Motoyama Y, Ogi S, Nabeshima S. Pontine glioblastoma multiforme initially presenting with leptomeningeal gliomatosis. Neurol Med Chir (Tokyo) 2002; 42:309-13. [PMID: 12160312 DOI: 10.2176/nmc.42.309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 49-year-old female presented with diffuse leptomeningeal gliomatosis as the initial manifestation of pontine glioblastoma. Magnetic resonance imaging initially revealed diffuse leptomeningeal enhancement caused by metastatic deposits, predominantly along the basal cistern and bilateral sylvian fissures. The primary pontine lesion appeared as hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging, but with no enhancement by gadolinium-diethylenetriaminepenta-acetic acid. There was no diffuse enlargement of the pons. The patient died 11 months after the initial presentation. The primary lesion in the pons was histologically confirmed at autopsy. Diffuse enhancement of leptomeningeal dissemination may occur as the initial manifestation of non-enhanced pontine glioblastoma.
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11
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Hill MD, Mackenzie I, Mason WP. Radiation-induced glioma presenting as diffuse leptomeningeal gliomatosis: a case report. J Neurooncol 2001; 55:113-6. [PMID: 11817701 DOI: 10.1023/a:1013337802429] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Leptomeningeal gliomatosis is a rare and fatal disease. METHODS Case report. RESULTS We report the case of a man who was presented with severe intractable headaches, lymphocytic CSF pleocytosis, and spinal leptomeningeal enhancement on contrast MRI. Meningeal biopsy demonstrated diffuse infiltration by malignant glial cells, and symptom alleviation was achieved by CSF diversion. He later developed an enhancing thalamic tumor arising within the treatment field of a remotely irradiated pituitary adenoma. Subsequent management included chemotherapy and further radiotherapy with transient response, before death from leptomeningeal and parenchymal tumor progression 16 months after diagnosis. CONCLUSION We report a unique case embodying two rare conditions: radiation induced glioma and leptomeningeal gliomatosis. Our patient's course is novel in that symptomatic relief was achieved with CSF diversion and a combination of chemotherapy and focal radiation allowed prolonged survival.
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Affiliation(s)
- M D Hill
- Department of Medical Oncology and Hematology, Princess Margaret Hospital, Toronto, Ontario, Canada
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Abstract
A 23-year-old female university student was presented with recent onset of non-specific headache and dizziness. She had no neurological deficit on neurological examination and magnetic resonance imaging of the brain revealed diffuse enhancement in the basal cisterns and cerebral sulci. She was treated as tuberculous meningitis but she did not improve and developed respiratory arrest. Autopsy showed primary multifocal leptomeningeal gliomatosis.
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Affiliation(s)
- E Y Tsui
- Department of Radiology, Tuen Mun Hospital, Hong Kong, NT, PR China
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Abstract
Many noninfectious diseases can cause signs, symptoms, and cerebrospinal fluid (CSF) abnormalities simulating central nervous system (CNS) infection. Infection usually can be excluded in these cases by the judicious use of serologic tests and CSF stains and cultures. Then, the correct diagnosis is typically suggested by the history and the concomitant presence of clinical and laboratory evidence of disease in other organ systems. Occasionally, particularly when such evidence is absent, the distinction requires meningeal or brain biopsy.
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Affiliation(s)
- J A De Marcaida
- Chief Resident, Department of Neurology, School of Medicine, University of Connecticut Health Center, Farmington, Connecticut 06030, USA
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Paulino AC, Thomas C, Slomiany DJ, Suarez CR. Diffuse malignant leptomeningeal gliomatosis in a child: a case report and review of the literature. Am J Clin Oncol 1999; 22:243-6. [PMID: 10362329 DOI: 10.1097/00000421-199906000-00006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Diffuse leptomeningeal gliomatosis is a rare condition characterized by glioma in the leptomeninges without a dominant mass lesion. The difficulty in diagnosis of this condition, its rarity. and its extensive nature have hampered its successful treatment. Most cases of primary diffuse leptomeningeal gliomatosis have occurred in adults. Reported here is a case of this condition in a 9-year-old girl; to the authors' knowledge, she is the youngest patient with diffuse leptomeningeal gliomatosis and the longest survivor of the malignant variety.
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Affiliation(s)
- A C Paulino
- Department of Radiotherapy, Cardinal Bernardin Cancer Center and Ronald McDonald Children's Hospital, Loyola University Medical Center, Maywood, Illinois, USA
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Singh M, Corboy JR, Stears JC, Kleinschmidt-DeMasters BK. Diffuse leptomeningeal gliomatosis associated with multifocal CNS infarcts. SURGICAL NEUROLOGY 1998; 50:356-62; discussion 362. [PMID: 9817460 DOI: 10.1016/s0090-3019(97)00371-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Widespread dissemination of astrocytoma throughout the cerebrospinal fluid is unusual, especially as the initial presentation in a patient, and association with cerebral infarcts is rare. CASE DESCRIPTION A 47-year-old man subacutely developed progressive headache and backache, vomiting, altered consciousness, and numbness in both arms. Brain computerized axial tomography showed calcification in the fourth ventricle and magnetic resonance imaging demonstrated diffuse meningeal enhancement, a lesion in the canal of Magendie, and T2-weighted hyperintense lesions in several locations. Angiography showed vasospasm/vasculopathy involving multiple cerebral vessels. Biopsy of the fourth ventricular mass revealed a subependymoma with an overlying leptomeningeal anaplastic astrocytoma with numerous Rosenthal fibers. The patient was treated with three doses of intrathecal methotrexate via lumbar puncture but suddenly became unresponsive and died 6 days later, 8 weeks after initial symptoms. Autopsy demonstrated the subependymoma and a widespread leptomeningeal anaplastic astrocytoma, which showed no clear-cut origin from the subependymoma, but microscopically infiltrated the left medial temporal lobe. Multiple subacute and acute infarcts of the brain, brain stem, and upper spinal cord were seen only in areas with leptomeningeal tumor. CONCLUSION Glioma cells surrounding and focally permeating central nervous system vessels without lumenal occlusion can lead to vasospasm and widespread infarcts.
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Affiliation(s)
- M Singh
- Department of Pathology, University of Colorado Health Sciences Center, Denver 80262, USA
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Beauchesne P, Pialat J, Duthel R, Barral FG, Clavreul G, Schmitt T, Laurent B. Aggressive treatment with complete remission in primary diffuse leptomeningeal gliomatosis--a case report. J Neurooncol 1998; 37:161-7. [PMID: 9524095 DOI: 10.1023/a:1005888319228] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Primary leptomeningeal gliomatosis is rare, and the diffuse form (PLDG) is even more unusual. The following report is an example. A 17 year-old man developed a syndrome characterized by extensive basal and chronic spinal meningitis. Routine biological tests showed elevated levels of CSF proteins, and moderate mononuclear pleocytosis, with no direct evidence of neoplasia, leading to a diagnosis of chronic meningitis. A second meningeal biopsy, guided by MRI and performed in the left frontal region, led to the specific diagnosis of primary diffuse leptomeningeal gliomatosis. Treatment including ventricular and lumbar shunting, a course of cortico-spinal radiation, and three courses of an eight-drug systemic chemotherapy with intrathecal methotrexate lead to complete remission over 15 months. We believe that this is the first report of such a remission in the literature.
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Affiliation(s)
- P Beauchesne
- Service de Neurochirurgie, Centre Hospitalier Universitaire, Saint-Etienne, France
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Robertson PL, Pavkovic I, Donovan C, Blaivas M. Immature teratoma of the leptomeninges in an 8-year-old child: unusual presentation with recurrent transient oculomotor nerve palsies and rapid progression to diffuse brain infarction. J Child Neurol 1998; 13:143-5. [PMID: 9535239 DOI: 10.1177/088307389801300308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- P L Robertson
- Department of Neurology, The University of Michigan Medical Center, Ann Arbor, USA
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Park JS, van den Noort S, Kim RC, Walot I, Licht H. Primary diffuse leptomeningeal gliomatosis with signs of increased intracranial pressure and progressive meningeal enhancement on MRI. J Neuroimaging 1996; 6:250-4. [PMID: 8903081 DOI: 10.1111/jon199664250] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
A 21-year-old woman presented with a 5-month history of meningeal signs and evidence of intracranial hypertension and, as shown by magnetic resonance imaging (MRI), progressively more extensive meningeal enhancement, particularly within the spinal canal. Autopsy disclosed the presence of primary diffuse leptomeningeal gliomatosis with spinal cord predominance, possibly arising within heterotopic leptomeningeal glial tissue in the cervical region. No parenchymal primary lesion was identified. MRI with gadolinium appears to be the imaging modality of choice for the early detection of primary diffuse leptomeningeal neoplasia.
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Affiliation(s)
- J S Park
- Department of Neurosurgery, University of New Mexico, Albuquerque, USA
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