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J Neurol Surg A Cent Eur Neurosurg 2013; 74(S 01): e159-e165
DOI: 10.1055/s-0032-1333417
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Bilateral Ptosis as Initial Presentation of Gliomatosis Cerebri: Case Report

Timothy Kovanda
1   Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, United States
,
John Braca
1   Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, United States
,
Vikram Prabhu
1   Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, United States
› Author Affiliations
Further Information

Publication History

01 May 2012

20 October 2012

Publication Date:
20 February 2013 (online)

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Abstract

Gliomatosis cerebri is a rare, diffuse glioma of neuroepithelial origin involving more than two cerebral lobes. Clinical presentation of gliomatosis cerebri is variable and depends on the degree, extent, and location of cortical involvement. Signs and symptoms related to supratentorial cortical involvement predominate and the diagnosis is reached through a combination of clinical, radiographic, and histopathological evaluations. This is a report of a young man who presented with visual problems and bilateral ptosis, which were eventually attributed to gliomatosis cerebri. Standard radiation and chemotherapy were administered but the patient eventually succumbed to the disease. The unique clinical presentation is discussed in light of this rare neoplasm of the central nervous system.

Keywords

gliomatosis cerebri - ptosis - radiation therapy - temozolomide
 

  • References

  • 1 Lantos PL, Bruner JM. Gliomatosis cerebri. In: Kleihues P, Cavenee WK, , eds. Pathology and Genetics: Tumors of the Nervous System. Lyon: IARC Press; 2000: 92-93
    Google Scholar
  • 2 Taillibert S, Chodkiewicz C, Laigle-Donadey F, Napolitano M, Cartalat-Carel S, Sanson M. Gliomatosis cerebri: a review of 296 cases from the ANOCEF database and the literature. J Neurooncol 2006; 76: 201-205
    CrossrefPubMedGoogle Scholar
  • 3 Vates GE, Chang S, Lamborn KR, Prados M, Berger MS. Gliomatosis cerebri: a review of 22 cases. Neurosurgery 2003; 53: 261-271 , discussion 271
    CrossrefPubMedGoogle Scholar
  • 4 del Carpio-O'Donovan R, Korah I, Salazar A, Melançon D. Gliomatosis cerebri. Radiology 1996; 198: 831-835
    PubMedGoogle Scholar
  • 5 Asada T, Takayama Y, Tokuriki Y, Fukuyama H. Gliomatosis cerebri presenting as a parkinsonian syndrome. J Neuroimaging 2007; 17: 269-271
    CrossrefPubMedGoogle Scholar
  • 6 Belsare G, Lee AG, Maley J, Kirby P, St Louis EK, Follett K. Pseudo-subarachnoid hemorrhage and cortical visual impairment as the presenting sign of gliomatosis cerebri. Semin Ophthalmol 2004; 19: 78-80
    CrossrefPubMedGoogle Scholar
  • 7 Kararizou E, Likomanos D, Gkiatas K, Markou I, Triantafyllou N, Kararizos G. Magnetic resonance spectroscopy: a noninvasive diagnosis of gliomatosis cerebri. Magn Reson Imaging 2006; 24: 205-207
    CrossrefPubMedGoogle Scholar
  • 8 Kong DS, Kim ST, Lee JI , et al. Impact of adjuvant chemotherapy for gliomatosis cerebri. BMC Cancer 2010; 10: 424-429
    CrossrefPubMedGoogle Scholar
  • 9 Louis DN, Ohgaki H, Wiestler OD , et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 2007; 114: 97-109
    CrossrefPubMedGoogle Scholar
  • 10 Park S, Suh YL, Nam DH, Kim ST. Gliomatosis cerebri: clinicopathologic study of 33 cases and comparison of mass forming and diffuse types. Clin Neuropathol 2009; 28: 73-82
    PubMedGoogle Scholar
  • 11 Fuller GN, Scheithauer BW. The 2007 revised world health organization (WHO) classification of tumours of the central nervous system: newly codified entities. Brain Pathol 2007; 17: 304-307
    CrossrefPubMedGoogle Scholar
  • 12 Clauser LC, Tieghi R, Galiè M. Palpebral ptosis: clinical classification, differential diagnosis, and surgical guidelines: an overview. J Craniofac Surg 2006; 17: 246-254
    CrossrefPubMedGoogle Scholar
  • 13 Finsterer J. Ptosis: causes, presentation, and management. Aesthetic Plast Surg 2003; 27: 193-204
    CrossrefPubMedGoogle Scholar
  • 14 Dexter MA, Parker GD, Besser M, Ell J, Fulham MJ. MR and positron emission tomography with fludeoxyglucose F 18 in gliomatosis cerebri. AJNR Am J Neuroradiol 1995; 16: 1507-1510
    PubMedGoogle Scholar
  • 15 Bühring U, Herrlinger U, Krings T, Thiex R, Weller M, Küker W. MRI features of primary central nervous system lymphomas at presentation. Neurology 2001; 57: 393-396
    CrossrefPubMedGoogle Scholar
  • 16 Küker W, Nägele T, Korfel A , et al. Primary central nervous system lymphomas (PCNSL): MRI features at presentation in 100 patients. J Neurooncol 2005; 72: 169-177
    CrossrefPubMedGoogle Scholar
  • 17 Schaefer PW, Grant PE, Gonzalez RG. Diffusion-weighted MR imaging of the brain. Radiology 2000; 217: 331-345
    CrossrefPubMedGoogle Scholar
  • 18 Al-Okaili RN, Krejza J, Wang S, Woo JH, Melhem ER. Advanced MR imaging techniques in the diagnosis of intraaxial brain tumors in adults. Radiographics 2006; 26 (Suppl. 01) S173-S189
    CrossrefPubMedGoogle Scholar
  • 19 Horger M, Fenchel M, Nägele T , et al. Water diffusivity: comparison of primary CNS lymphoma and astrocytic tumor infiltrating the corpus callosum. AJR Am J Roentgenol 2009; 193: 1384-1387
    CrossrefPubMedGoogle Scholar
  • 20 Galanaud D, Chinot O, Nicoli F , et al. Use of proton magnetic resonance spectroscopy of the brain to differentiate gliomatosis cerebri from low-grade glioma. J Neurosurg 2003; 98: 269-276
    CrossrefPubMedGoogle Scholar
  • 21 Guzmán-de-Villoria JA, Sánchez-González J, Muñoz L , et al. 1H MR spectroscopy in the assessment of gliomatosis cerebri. AJR Am J Roentgenol 2007; 188: 710-714
    CrossrefPubMedGoogle Scholar
  • 22 Elshaikh MA, Stevens GH, Peereboom DM , et al. Gliomatosis cerebri: treatment results with radiotherapy alone. Cancer 2002; 95: 2027-2031
    CrossrefPubMedGoogle Scholar
  • 23 Perkins GH, Schomer DF, Fuller GN, Allen PK, Maor MH. Gliomatosis cerebri: improved outcome with radiotherapy. Int J Radiat Oncol Biol Phys 2003; 56: 1137-1146
    CrossrefPubMedGoogle Scholar
  • 24 Levin N, Gomori JM, Siegal T. Chemotherapy as initial treatment in gliomatosis cerebri: results with temozolomide. Neurology 2004; 63: 354-356
    CrossrefPubMedGoogle Scholar
  • 25 Sanson M, Cartalat-Carel S, Taillibert S , et al; ANOCEF group. Initial chemotherapy in gliomatosis cerebri. Neurology 2004; 63: 270-275
    CrossrefPubMedGoogle Scholar
  • 26 Glas M, Bähr O, Felsberg J , et al; Neuro-Oncology Group of the German Cancer Society. NOA-05 phase 2 trial of procarbazine and lomustine therapy in gliomatosis cerebri. Ann Neurol 2011; 70: 445-453
    CrossrefPubMedGoogle Scholar