Schettino Carla, Caranci Ferdinando, Lus Giacomo, Signoriello Elisabetta, Eoli Marica, Anghileri Elena, Pollo Bianca, Melone Mariarosa A B, Di Iorio Giuseppe, Finocchiaro Gaetano, Ugga Lorenzo, Tedeschi Enrico
Unit of Molecular Neuro-Oncology, Fondazione I.R.C.C.S. Istituto Neurologico "C. Besta", Milan, Italy.
Division of Neurology, Department of Clinical and Experimental Medicine and Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
Quant Imaging Med Surg. 2017 Oct;7(5):592-597. doi: 10.21037/qims.2017.06.09.
We report the case of a young man with sudden onset of diplopia after an upper respiratory tract infection. Based on the first radiological findings acute hemorrhagic leukoencephalitis, a variant of acute disseminated encephalomyelitis, was suspected and treatment with high dose intravenous dexamethasone was started but it was stopped for intolerance. The patient clinically worsened, developing gait instability, ataxia and ophthalmoplegia; brain MRI performed 20 days later showed severe progression of the disease with subependymal dissemination. After brain biopsy of the right temporal lesion the histological diagnosis was glioblastoma. These findings suggest that MRI features of acute hemorrhagic leukoencephalitis may dissimulate the diagnosis of diffuse glioma/glioblastoma. This case underscores the importance of considering diffuse glioma in the differential diagnosis of atypical signs and symptoms of acute hemorrhagic leukoencephalitis and underlines the relevant role of integrating neuroradiologic findings with neuropathology.
我们报告了一例年轻男性病例，该患者在上呼吸道感染后突然出现复视。基于最初的影像学检查结果，怀疑为急性出血性白质脑炎（急性播散性脑脊髓炎的一种变体），并开始使用大剂量静脉注射地塞米松进行治疗，但因不耐受而停药。患者临床症状恶化，出现步态不稳、共济失调和眼肌麻痹；20天后进行的脑部MRI显示疾病严重进展并伴有室管膜下播散。对右侧颞叶病变进行脑活检后，组织学诊断为胶质母细胞瘤。这些发现表明，急性出血性白质脑炎的MRI特征可能会掩盖弥漫性胶质瘤/胶质母细胞瘤的诊断。该病例强调了在急性出血性白质脑炎非典型体征和症状的鉴别诊断中考虑弥漫性胶质瘤的重要性，并强调了将神经放射学检查结果与神经病理学相结合的相关作用。
