Bitemporal Multicentric High Grade Gliomas: A Case Report

摘要

Multicentric gliomas are aggressive and uncommon lesions of the central nervous system(CNS) . Multicentric high grade gliomas often have a distinct neuroimaging pattern with poor prognosis. These multicentric gliomas may be either metachronous or synchronous.We present a case of synchronous high grade multicentric gliomas involving the temporal lobes in a young patient who presented with mild symptoms and had no neurological deficits .He was operated for both the lesions and underwent radiotherapy for the same. Although it is difficult to diagnose and treat multicentric gliomas the aim of the surgeon must be to remove the largest and /or the nearest and most accessible lesion without causing additional neurological deficits. Further management, either radiotherapy or chemotherapy is based on the histopathological diagnosis. Case Report A 26 year old Right handed male came with complaints of bitemporal headache, nausea, and one episode of generalized tonic clonic convulsions. Patient was seen by a general practitioner and started on anticonvulsants. On general examination patient was well nourished, there were no neurocutaneous Markers on the body. On neurological examination the patient was conscious oriented, and the higher functions were normal. The motor, sensory system, were also normal, and there was no neurological deficit. Fundoscopy showed evidence of bilateral papilloedema.CT scan with contrast showed 2 separate lesions involving the temporal lobes having a mixed density and enhancing on contrast (figure1). MRI with contrast also showed mixed intensity lesions the right being larger then the left side with enhancement on contrast and surrounding edema (figure 2).