Atormac
Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 5696  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
 Search
 
  
 Resource Links
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (1,248 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this Article
   References
   Article Figures

 Article Access Statistics
    Viewed1046    
    Printed12    
    Emailed0    
    PDF Downloaded41    
    Comments [Add]    

Recommend this journal

 


 
Table of Contents    
NEUROIMAGES
Year : 2016  |  Volume : 64  |  Issue : 6  |  Page : 1376-1377

The butterfly mystery


1 Department of Neurology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
2 Department of Pathology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
3 Department of Neurosurgery, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India

Date of Web Publication11-Nov-2016

Correspondence Address:
Dr. Vinod Puri
Department of Neurology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, Jawaharlal Nehru Marg, New Delhi - 110 002
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.193835

Rights and Permissions



How to cite this article:
Sharma S, Gupta A, Soni G, Saran RK, Srivastava AK, Puri V. The butterfly mystery. Neurol India 2016;64:1376-7

How to cite this URL:
Sharma S, Gupta A, Soni G, Saran RK, Srivastava AK, Puri V. The butterfly mystery. Neurol India [serial online] 2016 [cited 2019 Aug 26];64:1376-7. Available from: http://www.neurologyindia.com/text.asp?2016/64/6/1376/193835


A 56-year-old woman presented with a 4-week history of headache, vomiting, and progressive bilateral vision loss; and, a 3-week history of left upper/lower limb weakness, altered behavior, and urinary incontinence. On examination, she was confused, had only perception of light in both eyes, papilledema and bi-pyramidal signs (left > right). Gadolinium enhanced magnetic resonance imaging (MRI) of the brain revealed a large peripherally enhancing bi-parietal mass crossing the corpus callosum with mass effect and peripheral diffusion restriction [Figure 1]a-f. Stereotactic biopsy of the lesion revealed active demyelination [Figure 2]a-d. She was given intravenous methylprednisolone 1 gram daily for 5 days followed by oral steroids tapered over 2 months. She had a remarkable improvement in all symptoms with final visual acuity of 6/24 bilaterally.
Figure 1: Magnetic resonance imaging of the brain. (a and b) T2-weighted and fluid-attenuated inversion recovery axial images show an hyperintense lesion involving corpus callosum; (c) Diffusion weighted images and (d) apparent diffusion coefficient maps show peripheral diffusion restriction. (e and f) Patchy peripheral contrast enhancement seen on T1 post contrast coronal and axial images

Click here to view
Figure 2: Pathology. (a) Luxol Fast Blue stain demonstrates relatively lighter stained area (arrow) corresponding to myelin loss. (b) Hematoxylin and eosin stained sections show a large number of foam cells (arrow). (c) Glial fibrillary acidic protein stain shows reactive astrocytes without nucleomegaly or pleomorphism. (d) neurofilament stain shows both preserved and broken axons

Click here to view


Demyelinating pseudotumor can clinically and radiologically mimic a mass lesion. The lesion is usually single and well-circumscribed but may rarely cross the corpus callosum resulting in a “butterfly pattern.”[1],[2] The differential diagnoses of such a pattern include glioblastoma multiforme, lymphomas with rare reports of progressive multifocal leukoencephalopathy,[2] metastasis, toxoplasmosis, and neuronal ceroid lipofuscinosis presenting similarly.[3]

Certain characteristic MRI features of demyelinating pseudotumor are the presence of a large sized lesion with minimal mass effect, open ring enhancement (incomplete portion on the gray matter side), T2 hypointense rim, peripheral diffusion restriction, and venular enhancement.[4] However, the diagnosis usually comes from a brain biopsy. Eighty percent patients show a significant response to corticosteroids. Thus, demyelination should be considered in the differential diagnosis of such lesions, as it is potentially treatable and carries a relatively favorable prognosis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Bower RS, Burrus TM, Giannini C, Erickson BJ, Meyer FB, Pirko I, et al. Teaching NeuroImages: Demyelinating disease mimicking butterfly high-grade glioma. Neurology 2010;75:e4-5.  Back to cited text no. 1
    
2.
Scozzafava J, Johnson ES, Blevins G. Neurological picture: Demyelinating butterfly pseudo-glioma. J Neurol Neurosurg Psychiatry 2008;79:12-3.  Back to cited text no. 2
    
3.
Agrawal A. Butterfly glioma of the corpus callosum. J Cancer Res Ther 2009;5:43-5.  Back to cited text no. 3
    
4.
Hardy TA, Chataway J. Tumefactive demyelination: An approach to diagnosis and management. J Neurol Neurosurg Psychiatry 2013;84:1047-53.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]



 

Top
Print this article  Email this article
   
Online since 20th March '04
Published by Wolters Kluwer - Medknow