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Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
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Persistent symmetrical white matter hyperintensities: a case report.

S A Paranavitane1, P Manokaran2, N T Wijesinghe2

  • 1Institute of Neurology, National Hospital of Sri Lanka, Colombo, Sri Lanka. shiran_p@live.com.

Journal of Medical Case Reports
|June 13, 2025
PubMed
Summary
This summary is machine-generated.

Anaplastic astrocytoma, a rare brain tumor, can unusually cause persistent, symmetrical white matter hyperintensities on MRI. This case highlights this uncommon presentation of a central nervous system tumor.

Keywords:
Anaplastic astrocytomaHyperintensitiesWhite matter

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Area of Science:

  • Neuro-oncology
  • Neuroradiology
  • Neuropathology

Background:

  • White matter hyperintensities (WMH) are common findings on magnetic resonance imaging (MRI).
  • However, WMH caused by anaplastic astrocytoma, a type of primary central nervous system tumor, is an unusual presentation.

Purpose of the Study:

  • To report an unusual case of anaplastic astrocytoma presenting with extensive, symmetrical white matter hyperintensities.

Main Methods:

  • A case study of a 22-year-old male with a month of headaches, altered awareness, and decreased consciousness.
  • Diagnostic workup included computed tomography (CT) and magnetic resonance imaging (MRI) of the brain, cerebrospinal fluid (CSF) analysis, and ventricular wall biopsy.
  • Treatment involved external ventricular drainage, intravenous fluids, dexamethasone, ceftriaxone, and acyclovir, with subsequent referral for oncological management.

Main Results:

  • MRI revealed extensive, symmetrical T2 and fluid-attenuated inversion recovery (FLAIR) hyperintensities in the white matter and cerebellar hemispheres.
  • Initial treatments and CSF analysis showed no significant improvement or identifiable infection.
  • A ventricular wall biopsy confirmed anaplastic astrocytoma (WHO Grade III).

Conclusions:

  • This case underscores the importance of considering primary central nervous system tumors in the differential diagnosis of unusual white matter abnormalities.
  • Anaplastic astrocytoma can present atypically with persistent, symmetrical white matter hyperintensities on MRI.