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Case Report

Primary Diffuse Leptomeningeal Gliomatosis Primararily Involving the Spinal Cord Simulating Tuberculous Meningitis

Naresh Kumar Gajjala, Senior Resident, Department of Neurosurgery, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, Telangana 500082, India. , Naresh Kumar Gajjala* , Vamsi krishna Yerramneni** , Ratnakar Vupputuri*** , Megha Uppin****

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International Journal of Neurology and Neurosurgery 9(2):p 194-197, Jul-Dec 2017. | DOI: http://dx.doi.org/10.21088/ijnns.0975.0223.9217.19

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Abstract

Primary leptomeningeal gliomatosis is a rare, neoplastic syndrome which is highly fatal. Here is a 15 year female presenting with weakness of both lower limbs for 3 months of duration. Started on ATT presuming as tuberculous meningitis. MRI studies showed subacute infarcts in the medulla, B/l cerebellar hemisphere and superior vermis, abnormal basal enhancement, and meningeal enhancement in prepontine and premedullary region, edematous cord with T2, STIR hyperintensities from D3 to D10 and with D6 to D12 diffuse nodular intramedullary and dural enhancement. CSF analysis showed increase in protein ,with low glucose with no malignant cells. Weakness progressed rapidly for last 10 days and the patient succumbed to death after receiving 2 cycles of radiotherapy. Histopathology showed leptomeningeal gliomatosis (IHC: GFAPstrongly positive in tumour cells, with Ki6720%) in the spinal subdural lesion. Suspected morphology should be differentiated with conditions like cord astrocytoma, lymphoma, sarcoid, tuberculosis and leptomeningeal gliomatosis should be ruled out in case of rapidly progressing disease course.

 

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DOI: http://dx.doi.org/10.21088/ijnns.0975.0223.9217.19

Keywords

Leptomenginges; Fibrillary Variant; Diffuse Enhancement; Nervous System; Weakness of Limbs. 

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