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Gliomatosis cerebri angiographically mimicking central nervous system angiitis: case report
Boby V Maramattom1, Caterina Giannini, Edward M Manno
1Division of Critical Care Neurology, Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Objective:
The diagnosis of isolated central nervous system angiitis often requires both cerebral angiography and biopsy for diagnosis.
Clinical Presentation:
We present a case of gliomatosis cerebri with demonstrated angiographic changes suggestive of a central nervous system vasculitis.
Intervention:
A 47-year-old woman presented with a 2-week history of worsening headache and progressive drowsiness. Magnetic resonance imaging scans revealed confluent nonenhancing T2-weighted hyperintensity involving the frontal white matter bilaterally, hypothalamus, and both thalami. A four-vessel angiogram revealed diffuse arterial beading with stenoses of a right frontal middle cerebral artery branch and the distal posterior cerebral artery and anterior cerebral artery branches, bilaterally. The biopsy revealed a Grade 2 fibrillary astrocytoma consistent with gliomatosis cerebri.
Conclusion:
Gliomatosis cerebri can mimic central nervous system vasculitis angiographically. Perivascular infiltration by tumor cells may be responsible for these changes.