Department of Neurology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China.
Medicine (Baltimore). 2024 Feb 2;103(5):e37136. doi: 10.1097/MD.0000000000037136.
Bilateral thalamic glioma is extremely rare and characterized by strictly limited involvement of bilateral thalami. To investigate its clinical and neuroimaging features, we herein reported a rare case of anaplastic astrocytoma (AA) involving both thalami and the brainstem and reviewed the literature.
A-33-year-old Chinese woman was referred to our department owing to persistent headache and nausea and vomiting. Neurological examination showed mild cognitive impairment and positive Kernig sign.
Brain magnetic resonance imaging (MRI) demonstrated asymmetrical and swollen lesions involving both thalami, midbrain and pontine tegmentum, without restricted diffusion or enhancement. On day 7 after admission, she was transferred to the department of neurosurgery and underwent a stereotactic brain biopsy of the right thalamic lesion. Histopathological features and immunohistochemistry were consistent with AA, IDH wild-type, World Health Organization grade III.
She was administrated with mannitol and glycerin fructose for decreasing intracranial pressure.
In spite of receiving chemotherapy, she died on 2-month after her initial diagnosis.
AA involving in both thalami and brainstem is a rare entity with poor prognosis. The clinicians and radiologists should deepen their awareness of the specific MRI feature of bilateral thalamic involvement. When MRI alone is insufficient, the utility of stereotactic biopsy is essential for making a definitive diagnosis.
双侧丘脑胶质瘤极其罕见，其特征为严格局限于双侧丘脑。为了研究其临床和神经影像学特征，我们在此报告一例罕见的累及双侧丘脑和脑干的间变性星形细胞瘤（AA）病例，并复习了相关文献。
一位 33 岁的中国女性因持续性头痛、恶心和呕吐而被转至我科。神经系统检查显示轻度认知障碍和 Kernig 征阳性。
脑部磁共振成像（MRI）显示双侧丘脑、中脑和脑桥被盖部不对称性肿胀性病变，无弥散受限或增强。入院第 7 天，她被转至神经外科，接受了右侧丘脑病变的立体定向脑活检。组织病理学特征和免疫组织化学检查符合 IDH 野生型 AA，世界卫生组织分级为 3 级。
给予甘露醇和甘油果糖降低颅内压。
尽管接受了化疗，但她在初始诊断后 2 个月死亡。
累及双侧丘脑和脑干的 AA 极为罕见，预后较差。临床医生和放射科医生应加深对双侧丘脑受累的特定 MRI 特征的认识。当 MRI 不充分时，立体定向活检对于明确诊断至关重要。
