A Case of Gliomatosis Cerebri Mimicking Limbic Encephalitis: Malignant Transformation to Glioblastoma
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概要
- 論文の詳細を見る
Gliomatosis cerebri (GC) is a specific entity defined as diffuse infiltration of neoplastic glial cells into at least three cerebral lobes and preservation of the surrounding neuronal architecture. We report a patient with secondary GC that mimicked clinicoradiological features of limbic encephalitis (LE). A 72-year-old man had developed headache and disorientation insidiously 2 weeks previously. On admission, neurological examination showed confusion and hyperreflexia in the right extremities. Brain magnetic resonance imaging (MRI) revealed T2-hyperintensity in bilateral frontal, the left parietal, the left temporal lobes and bilateral posterior periventricular zones. Slight enhancement existed in the left lower temporal region. Cerebral angiography exhibited no tumor stains. Repeated cerebrospinal fluid studies showed mild pleocytosis and cytology of class I. There were no infectious pathogenic agents. His neurological symptoms were ameliorated at 7 days after treatment with dexamethasone and glycerol. Follow-up MRI showed no pathognomonic changes. Mild memory dysfunction remained. He was diagnosed as LE of unknown cause. Three months later he became disorientated. Brain CT revealed a hemorrhagic mass with surrounding edema in the left temporal, frontal and parietal lobes. MRI displayed marked enhancement in these regions. Urgent neurosurgery was performed and glioblastoma multiforme (GM) was confirmed pathologically. The early clinicoradiological course of this patient suggested similarities to LE. At 3 months after clinical onset, the neuroradiological features reflected rapid transformation from secondary GC to massive GM. Thus, it is important to pay more attention to the differential diagnoses of GC and LE in patients who have memory deficits and widespread MRI lesions.
著者
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Nakamura Yoshikazu
Department of Neurology, Toho University Omori Medical Center
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Miura Ken
Department of Neurology, Toho University Omori Medical Center
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Kawabe Kiyokazu
Department of Neurology, Toho University Omori Medical Center
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Iwasaki Yasuo
Department of Neurology, Toho University Omori Medical Center
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Ishikawa Yuichi
Department Of Applied Chemistry Faculty Of Engineering Oita University
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Miura Ken
Department Of Medical Zoology School Of Medicine
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Iwasaki Yasuo
Department Of Neurology Toho University Ohmori Hospital
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Nakamura Yoshikazu
Department Of Basic Medical Sciences Institute Of Medical Science University Of Tokyo
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IKEDA Ken
Department of Cardiovascular and Respiratory Medicine, Akita University Graduate School of Medicine
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Sato Ryuta
Department of Hematology, Nephrology, and Rheumatology, Akita University Graduate School of Medicine, Japan
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Kawase Yuji
Department of Neurology, Toho University Omori Medical Center
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Kawase Yuji
Department of Neurology, Oomori Hospital, Toho University
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Nagata Riya
Department of Neurology, Toho University Omori Medical Center
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Kawabe Kiyokazu
Department of Neurology, Oomori Hospital, Toho University
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