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|Year : 2019 | Volume
| Issue : 2 | Page : 615-616
Imaging in diffuse leptomeningeal glioneuronal tumor
Raj Ghoniya, Amol Raheja
Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India
|Date of Web Publication||13-May-2019|
Dr. Amol Raheja
Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ghoniya R, Raheja A. Imaging in diffuse leptomeningeal glioneuronal tumor. Neurol India 2019;67:615-6
Diffuse leptomeningeal glioneuronal tumor (DLGNT) was first described as a new entity in 2010; recently, it has been included in the World Health Organization classification of brain tumors, in the 2016 revision. It has been primarily described in the pediatric population.,, We report imaging findings of this rare condition in a 36-year old female patient, who presented with symptomatic hydrocephalus and a single episode of generalized tonic clonic seizures for which she required a ventriculoperitoneal shunt. She later developed bilateral cerebellar signs and spastic paraparesis with early bladder and bowel involvement, a surrogate clinical presentation for an intramedullary pathology. Imaging of this patient serves as an interesting outlook into this rare entity. Magnetic resonance imaging of brain and spine demonstrated multiple T1 hypointense, T2 hyperintense, fluid attenuated inversion recovery (FLAIR) hypointense, nonenhancing subpial cystic lesions along the cerebellar folia and spinal cord [Figure 1] and [Figure 2], giving a presumptive diagnosis of DLGNT based on its classical radiological signs. The largest lesion can be seen in the subpial location of D9–D10 spinal cord without any leptomeningeal enhancement [Figure 1] and [Figure 2]. The unique aspects of this DLGNT case include an adult-onset presentation, hydrocephalus with seizure as the primary presenting complaint, and lack of leptomeningeal contrast enhancement.
|Figure 1: (a) T1W axial brain MRI showing hypointense lesions along cerebellar folia bilaterally (arrow), which are hyperintense on T2W image (arrow) (b). (c) These lesions do not enhance on postcontrast images. (d) They remain hypointense on fluid attenuated inversion recovery (FLAIR) sequence (arrow). (e) A large subpial dorsal cord lesion (horizontal arrow) with smaller cystic lesions located anterolaterally (vertical arrow) are also seen on T2W axial image|
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|Figure 2: (a) T2W sagittal MRI brain image showing multiple subpial hyperintense lesions along the cerebellar folia (arrow), as well as in the cervicodorsal spinal cord (b). (c) In addition to the multiple subpial lesions (arrow) along the cervicodorsal spinal cord, there is a large subpial (arrowhead) lesion in the lower dorsal cord at the D9–D10 vertebral level. (d) The cystic subpial lesions extend up to the tip of conus (arrow). (e) Postcontrast image of the whole spine showing the nonenhancing nature of the leptomeninges, and the multiple subpial lesions as well as the intramedullary lesion|
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