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Images in Neurology |

Diffuse Leptomeningeal Astrocytoma in a Patient With Infantile Epilepsy

Clemens Warnke, MD; Rotem Shlomo Lanzman, MD; Barbara Klink, MD; Frank Schellhammer, MD; Guido Reifenberger, MD; Axel Methner, MD
Arch Neurol. 2009;66(3):408-409. doi:10.1001/archneurol.2008.574.
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A 29-year-old man was referred to us with a 2-week history of worsening headache, progressive visual loss, and increased frequency of seizures. At age 3 years, he had a severe general infection and subsequently developed obstructive hydrocephalus and complex focal epilepsy that was treated with a ventriculoperitoneal shunt and antiepileptic medication. He presented with severe visual loss due to optic nerve atrophy, cerebellar gait ataxia, and intention tremor. Magnetic resonance imaging disclosed a diffuse contrast-enhancing meningeal tumor mass surrounding the brain stem, in the posterior fossa, and along the spinal cord with additional cystic lesions in the cervical spinal cord. Interestingly, less pronounced meningeal tumor around the brainstem and cystic lesions in the spinal cord were already detected 3 years earlier. The cystic lesions in particular were almost unchanged (Figure, A).

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Figure.

Magnetic resonance imaging and meningeal biopsy specimen. A, Magnetic resonance imaging shows a dramatic increase of tumor masses around the brainstem with marked enhancement on T1-weighted images from 2005 to 2008. Additional cystic lesions within the spinal cord on T2-weighted images remained almost unchanged. B, Meningeal biopsy specimen shows a moderately cellular astrocytic glioma (hematoxylin-eosin) with strong microtubule-associated protein 2 immunopositivity (inset) (original magnification ×400).

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