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Anaplastic astrocytoma presenting as reversible posterior leukoencephalopathy syndrome

Tomokatsu Yoshida1, Fumitoshi Niwa, Satoshi Kimura

  • 1Research Institute for Neurological Diseases and Geriatrics, Department of Neurology and Gerontology, Kyoto Prefectural University of Medicine, Kyoto, Japan. tomo-kayo@k8.dion.ne.jp

The Neurologist
|November 24, 2006
PubMed

Insights

A brain tumor may mimic reversible posterior leukoencephalopathy syndrome (RPLS). Advanced imaging like SPECT is crucial for differentiating astrocytoma from RPLS, especially with atypical findings.

Area of Science:

  • Neuro-oncology
  • Neuroradiology
  • Neurology

Background:

  • Astrocytoma, a type of brain tumor, can present with complex neurological symptoms.
  • Status epilepticus is a neurological emergency requiring prompt diagnosis and management.
  • Reversible posterior leukoencephalopathy syndrome (RPLS) is a distinct neurological condition characterized by specific MRI findings.

Observation:

  • A 60-year-old male with grade III astrocytoma presented with status epilepticus.
  • Initial MRI revealed findings suggestive of RPLS, not typical for astrocytoma.
  • N-Isopropil-p-[I] iodoamphetamine single photon emission computed tomography (SPECT) showed hyperperfusion in the affected area.

Findings:

  • The case highlights a diagnostic challenge where astrocytoma mimicked RPLS on initial MRI.
  • SPECT imaging revealed hyperperfusion, an atypical finding for standard RPLS presentation.
  • This underscores the importance of considering brain tumors even with seemingly characteristic RPLS imaging patterns.

Implications:

  • Neuroimaging interpretation requires careful consideration of differential diagnoses, including brain tumors presenting atypically.
  • SPECT can provide crucial functional information to aid in differentiating between neoplastic and non-neoplastic conditions.
  • Patients with suspected RPLS and atypical SPECT findings warrant thorough investigation for underlying brain tumors.

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