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[Diagnostic difficulties in encephalitis and glioma]

S Parbel1, S Vlaho, B Gebhardt

  • 1Klinik für Allgemeine Kinderheilkunde, Johann-Wolfgang-Goethe-Universität Frankfurt am Main.

Klinische Padiatrie
|July 26, 2006
PubMed
Abstract

Insights

Cerebral glioma can mimic brain infections, making diagnosis difficult. Magnetic resonance spectroscopy (MRS) aids in differentiating these conditions, proving crucial for accurate diagnosis and treatment planning.

Area of Science:

  • Neuro-oncology
  • Pediatric Neurology
  • Diagnostic Imaging

Background:

  • Glial neoplasms present diagnostic challenges due to extensive CNS infiltration with preserved neuronal architecture.
  • Distinguishing cerebral glioma from infective lesions solely via MRI is often difficult.

Observation:

  • A 7-year-old boy presented with symptoms including vomiting, fever, weakness, and speech disturbance.
  • Initial MRI revealed diffuse mesencephalic and pontine swelling suggestive of infection, but investigations were inconclusive.
  • The patient relapsed despite empirical treatments, prompting further investigation.

Findings:

  • 1H-MR-spectroscopy demonstrated elevated choline and decreased N-acetyl-aspartate, indicative of a proliferating process.
  • Brain biopsy confirmed anaplastic astrocytoma (WHO III).
  • Despite aggressive treatment, the patient succumbed to progressive brainstem infiltration.

Implications:

  • This case highlights the potential for cerebral glioma to mimic infective brain disease.
  • Magnetic resonance spectroscopy (MRS) is a valuable non-invasive tool for the differential diagnosis of CNS lesions.
  • Early and accurate diagnosis is critical for effective management of pediatric brain tumors.

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