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Achhami E, Lamichhane S, Mahaju S, Adhikari L, Kandel A, Poudel A. Bilateral thalamic stroke due to occlusion of the artery of Percheron: A case report and literature review. Clin Case Rep 2023; 11:e8155. [PMID: 37953898 PMCID: PMC10632557 DOI: 10.1002/ccr3.8155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 11/14/2023] Open
Abstract
Bilateral thalamic infarction resulting from the occlusion of the artery of Percheron (AOP) is a rare cerebrovascular event with distinctive clinical presentations. This case report explores the intricate relationship between vascular anatomy, midbrain function, and clinical manifestations. A 48-year-old male farmer with a history of diabetes mellitus presented with sudden-onset visual disturbances, diplopia, bilateral eyelid drooping, and loss of consciousness. Extensive evaluations, including advanced imaging techniques, led to the diagnosis of bilateral upper midbrain infarction involving AOP. This case underscores the complexity of neurovascular interactions, highlighting the importance of precise diagnosis, and tailored management in addressing rare cerebrovascular conditions.
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Affiliation(s)
- Eliz Achhami
- Sukraraj Tropical & Infectious Disease HospitalKathmanduNepal
| | | | - Satyam Mahaju
- Sukraraj Tropical & Infectious Disease HospitalKathmanduNepal
| | | | - Ashim Kandel
- Sukraraj Tropical & Infectious Disease HospitalKathmanduNepal
| | - Anubhav Poudel
- Sukraraj Tropical & Infectious Disease HospitalKathmanduNepal
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2
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Zhang D, Liang K, Yin J, Tang L, Yang X, Yang Z, Li X. Dural Arteriovenous Fistulas Presenting as Symmetric Lesions in the Internal Capsule on Imaging Studies: A Case Report and Literature Review. Neurologist 2023; 28:304-309. [PMID: 37146273 DOI: 10.1097/nrl.0000000000000490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Dural arteriovenous fistulas (DAVFs) leading to oedema, primarily in the internal capsule, are extremely rare and, to our knowledge, have never been reported. We reported a case of DAVFs with oedema in bilateral internal capsule oedema and reviewed the literature. METHODS The report describes a unique imaging presentation of cases of DAVFs as symmetric lesions, mainly in the bilateral internal capsule. It also reviews the literature for symmetric lesions in the internal capsule and central grey matter caused by DAVFs to further characterize this rare entity and differential diagnosis through imaging features. RESULTS In cases of symmetric oedema caused by DAVFs, the most common artery involved in arterial supply was the middle meningeal artery (13/24; 54%). The main vein involved in the drainage was the Galen vein (18/29; 62%). Most cases were treated with transarterial embolization (23/29; 79%), and the probability of effective treatment or complete cure is 100%. On imaging, the vasogenic oedema signal caused by DAVFs is a symmetrical lesion of the bilateral internal capsule, that is, DWI MRI shows a high signal in the unrestricted diffusion area on the apparent diffusion coefficient map. CONCLUSIONS MR has good diagnostic value in abnormal basal ganglia symmetric signals caused by DAVFs, and can quickly identify DAVFs early.
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Affiliation(s)
- Daihui Zhang
- Department of CT and Nuclear magnetic, Xingtai Third Hosptial, Xingtai, 054000 China
| | - Kuopeng Liang
- Department of Ultrasound, Xingtai People's Hosptial, Xingtai, 054000 China
| | - Juntao Yin
- Department of Ultrasound, Xingtai People's Hosptial, Xingtai, 054000 China
| | - Lingtao Tang
- Department of Ultrasound, Xingtai People's Hosptial, Xingtai, 054000 China
| | - Xiaoyi Yang
- Department of Ultrasound, Xingtai People's Hosptial, Xingtai, 054000 China
| | - Zhihong Yang
- Department of Ultrasound, Xingtai People's Hosptial, Xingtai, 054000 China
| | - Xingliang Li
- Department of Ultrasound, Xingtai People's Hosptial, Xingtai, 054000 China
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3
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Xu K, Sun Z, Wang L, Guan W. Bilateral Thalamic Gliomas Harboring Alterations of EGFR and H3K27M: An Integrated Clinicopathological Characteristics Case Series. World Neurosurg 2022; 168:e442-e450. [PMID: 36195182 DOI: 10.1016/j.wneu.2022.09.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Bilateral thalamic gliomas (BTGs) are rare central nervous system tumors, and the outcome is usually dismal. BTG often harbors an EGFR mutation; however, a mutation in H3K27M is rare. We described 5 cases of BTGs harboring concomitant alterations of EGFR and H3K27M and retrospectively analyzed the clinicopathological features and prognosis of this rare entity. METHODS Clinical data of patients were retrieved, and immunohistochemistry and molecular analyses were performed. In addition, a systematic review of literature was conducted using PubMed. RESULTS Median patient age was 6 years (range, 3-9 years). The male-to-female ratio was 3:2. Tremors and disturbed speech were the main clinical manifestations. All lesions were located at bilateral thalami, and in 3 of 4 patients, the more significant thalamic lesion was on the left. Two patients harbored insertion mutations in exon 20 of EGFR, 1 missense mutation in exon 7 of EGFR, and 2 EGFR amplifications. After a median overall survival of 8 months, 3 patients died as a result of tumor progression. CONCLUSIONS Concomitant alterations of EGFR and H3K27M might indicate a new subtype of diffuse midline glioma, H3K27M-altered. In addition, EGFR alterations could provide potential molecular therapeutic strategies to improve the dismal prognosis of BTGs. Due to the rarity of these tumors, more cases must be collected to study the pathogenesis, treatment, and clinical outcomes of BTGs with double alteration phenotypes.
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Affiliation(s)
- Kailun Xu
- Department of Pathology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhaoyun Sun
- Department of Cardiothoracic Surgery, Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lifeng Wang
- Department of Pathology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenbin Guan
- Department of Pathology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Badejo O, Osobu B, Salami A, Adeyinka A, Shokunbi M. Paediatric bilateral thalamic glioma: Case report and literature review. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.100499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Niu X, Wang T, Yang Y, Gan Y, Li J, Liu Y, Mao Q. Prognostic Factors for the Survival Outcome of Bilateral Thalamic Glioma: An Integrated Survival Analysis. World Neurosurg 2018; 110:e222-e230. [DOI: 10.1016/j.wneu.2017.10.132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 10/22/2017] [Accepted: 10/24/2017] [Indexed: 12/11/2022]
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6
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Holekamp TF, Mollman ME, Murphy RKJ, Kolar GR, Kramer NM, Derdeyn CP, Moran CJ, Perrin RJ, Rich KM, Lanzino G, Zipfel GJ. Dural arteriovenous fistula-induced thalamic dementia: report of 4 cases. J Neurosurg 2016; 124:1752-65. [DOI: 10.3171/2015.5.jns15473] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Nonhemorrhagic neurological deficits are underrecognized symptoms of intracranial dural arteriovenous fistulas (dAVFs) having cortical venous drainage. These symptoms are the consequence of cortical venous hypertension and portend a clinical course with increased risk of neurological morbidity and mortality. One rarely documented and easily misinterpreted type of nonhemorrhagic neurological deficit is progressive dementia, which can result from venous hypertension in the cortex or in bilateral thalami. The latter, which is due to dAVF drainage into the deep venous system, is the less common of these 2 dementia syndromes. Herein, the authors report 4 cases of dAVF with venous drainage into the vein of Galen causing bithalamic edema and rapidly progressive dementia. Two patients were treated successfully with endovascular embolization, and the other 2 patients were treated successfully with endovascular embolization followed by surgery. The radiographic abnormalities and presenting symptoms rapidly resolved after dAVF obliteration in all 4 cases. Detailed descriptions of these 4 cases are presented along with a critical review of 15 previously reported cases. In our analysis of these 19 published cases, the following were emphasized: 1) the clinical and radiographic differences between dAVF-induced thalamic versus cortical dementia syndromes; 2) the differential diagnosis and necessary radiographic workup for patients presenting with a rapidly progressive thalamic dementia syndrome; 3) the frequency at which delays in diagnosis occurred and potentially dangerous and avoidable diagnostic procedures were used; and 4) the rapidity and completeness of symptom resolution following dAVF treatment.
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Affiliation(s)
| | | | | | | | | | - Colin P. Derdeyn
- Departments of 1Neurological Surgery,
- 4Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, Missouri; and
- 5Neurology, and
| | - Christopher J. Moran
- Departments of 1Neurological Surgery,
- 4Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, Missouri; and
| | | | - Keith M. Rich
- Departments of 1Neurological Surgery,
- 4Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, Missouri; and
| | - Giuseppe Lanzino
- 3Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
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Zhang P, Wang X, Ji N, Xie J, Han J, Ren X, Song G, Wu R, Zhang L, Gao Z. Clinical, radiological, and pathological features of 33 adult unilateral thalamic gliomas. World J Surg Oncol 2016; 14:78. [PMID: 26965578 PMCID: PMC4785741 DOI: 10.1186/s12957-016-0820-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/29/2016] [Indexed: 12/26/2022] Open
Abstract
Background Unilateral adult thalamic gliomas are rarely reported. In this study, the authors aimed to analyze the clinical, radiological, and pathological features of adult primary unilateral thalamus gliomas (UTGs). Methods Clinical data of 33 UTGs in adults who underwent surgical treatment between 2005 and 2014 at the Beijing Tiantan Hospital were collected and retrospectively studied. Follow-up evaluation was performed. Results This study included 21 males and 12 females with a mean age of 43.1 years. The most common symptoms were headache (75.8 %, 25/33 patients) and motor deficits (42.4 %, 14/33 patients). Radiological results showed that enhancement was common (90.9 %, 30/33 patients) and included cystic appearances in 9 cases (27.3 %). All patients underwent maximal safe tumor resection. Gross total resection (GTR) was achieved in 19 cases, subtotal resection (≥80 %) in 9 cases, and partial resection (<80 %) in 5 cases. Molecular pathology results were available in 15 cases. After surgery, 25 patients received postoperative adjuvant therapy based on the remaining pathology. The median follow-up period of all 33 patients with UTGs was 17 months (1 week~49 months). Twenty-four patients experienced tumor recurrence. The 1-year and 2-year progression-free survival (PFS) rates were 49.0 and 10.2 %, respectively. The 1-year and 2-year overall survival (OS) rates were 68.1 and 25.9 %, respectively. Survival analyses revealed that several predictive factors were correlated with better prognosis, among which, GTR and tumor with cystic appearances were significantly associated with a longer survival. Conclusions Adult UTGs displayed a wide spectrum of clinical features. GTR can be achieved in adult UTGs with acceptable complications and conferred a better prognosis. Tumor with cystic appearance may indicate better prognosis. More patients and longer follow-up periods are needed to further elucidate the biological features of adult UTGs. Electronic supplementary material The online version of this article (doi:10.1186/s12957-016-0820-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Peng Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, 100050, China.,Beijing Key Laboratory of Brain Tumor, Beijing, 100050, China
| | - Xingchao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, 100050, China.,Beijing Key Laboratory of Brain Tumor, Beijing, 100050, China
| | - Nan Ji
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, 100050, China.,Beijing Key Laboratory of Brain Tumor, Beijing, 100050, China
| | - Jian Xie
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, 100050, China.,Beijing Key Laboratory of Brain Tumor, Beijing, 100050, China
| | - Jinsong Han
- Department of Neurosurgery, Beijing Puren Hospital, Beijing, 100069, China
| | - Xiaohui Ren
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, 100050, China.,Beijing Key Laboratory of Brain Tumor, Beijing, 100050, China
| | - Guidong Song
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, 100050, China.,Beijing Key Laboratory of Brain Tumor, Beijing, 100050, China
| | - Ruofei Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, 100050, China.,Beijing Key Laboratory of Brain Tumor, Beijing, 100050, China
| | - Liwei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, 100050, China.,Beijing Key Laboratory of Brain Tumor, Beijing, 100050, China
| | - Zhixian Gao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China. .,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, 100050, China. .,Beijing Key Laboratory of Brain Tumor, Beijing, 100050, China.
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Ganewatte E, Al-Zahrani Y, Purohit B, Kollias S. A case report on 1-year follow-up of bilateral thalamic glioma. Neuroradiol J 2015; 28:584-6. [PMID: 26463006 DOI: 10.1177/1971400915609342] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Bilateral thalamic glioma is one of the rarest tumor occurrences, representing a small fraction of thalamic gliomas, which only accounts for 1-1.5% of all brain tumors. It is usually a diffuse, low-grade astrocytoma (WHO grade II), seen mainly in adults, with approximately 25% of them involving children under the age of 15. Radiotherapy is the main mode of treatment since surgical intervention is limited to a role of biopsy and management of secondary effects, due to the deep brain location of the lesion and the complexity of the involved structures. We report a 1-year follow-up of a 55-year-old female patient with bilateral WHO grade II thalamic astrocytoma. Following histological and neuroradiological consensus regarding the diagnosis, the patient was referred for radiotherapy. The effectiveness of available therapy and long-term neuroradiological follow-up is not reliably established due to rapid fatal evolution following diagnosis. Contrary to the norm, our patient showed stable disease with radiotherapy for a 1-year period.
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Affiliation(s)
- Eranga Ganewatte
- Institute for Neuroradiology University Hospital of Zurich, Switzerland Royal Melbourne Hospital, Melbourne, Australia
| | - Yahea Al-Zahrani
- Institute for Neuroradiology University Hospital of Zurich, Switzerland
| | - Bela Purohit
- Institute for Neuroradiology University Hospital of Zurich, Switzerland
| | - Spyros Kollias
- Institute for Neuroradiology University Hospital of Zurich, Switzerland
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9
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Affiliation(s)
| | - Ai Tanaka
- Department of Neurology, Saitama Medical University, Japan
| | | | | | - Nobuo Araki
- Department of Neurology, Saitama Medical University, Japan
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10
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Kim JP, Kim SH, Chang JW, Park YG. Planned stereotactic biopsy of a bilateral thalamic glioma in a patient presenting with unilateral tremor. Acta Neurochir (Wien) 2012; 154:895-7. [PMID: 22389035 DOI: 10.1007/s00701-011-1271-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 12/29/2011] [Indexed: 10/28/2022]
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Abstract
OBJECTIVE Bilateral thalamic lesions are rare and relatively obscure neoplasms. We present our experience with nine cases of bilateral thalamic lesions and attempt to analyse them in the background of available literature. MATERIALS AND METHODS Retrospective analyses of the case records of 9 cases of bilateral thalamic lesions treated in our department since January 2002, which have a minimum of 1 year follow-up. RESULTS The study group included four males and five females with a mean age of 14.6 years (5 years to 29 years). Seven of these patients had radiological evidence of bilateral thalamic lesions at presentation and 2 patients had involvement of the opposite thalamus at a later stage of the disease. All patients except one presented with raised intracranial pressure symptoms. Focal motor deficits (4/9), behavioral and memory disturbances (3/9) were the other major presenting symptoms. Biopsy confirmation was possible in six patients and histopathology was suggestive of low grade fibrillary astrocytoma in all six patients. Seven patients required CSF diversion procedure for associated hydrocephalus. Eight of our nine patients underwent radiotherapy. On last follow-up, 3 patients were clinically stable with images suggestive of arrested disease, four patients had evidence of progressive disease both clinically and radiologically and there were two recorded cases of mortality. CONCLUSION Primary bilateral thalamic lesions have characteristic neuroradiological properties and are distinct from unilateral thalamic tumours with bilateral progression. Almost all of these lesions on histology prove to be gliomas but decompressive surgery is seldom feasible. Surgical intervention is limited to biopsy and CSF diversion for hydrocephalus. Bilateral thalamic lesions remain unresponsive to adjuvant therapy and generally carry a poor prognosis.
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Affiliation(s)
- G Menon
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences, & Technology, Trivandrum, India.
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Frosini D, Ceravolo R, Rossi C, Pesaresi I, Cosottini M, Bonuccelli U. Bilateral thalamic glioma presenting with parkinsonism. Mov Disord 2010; 24:2168-9. [PMID: 19735095 DOI: 10.1002/mds.22761] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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13
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Habek M, Brinar VV, Mubrin Z, Barun B, Zarković K. Bilateral thalamic astrocytoma. J Neurooncol 2007; 84:175-7. [PMID: 17522784 DOI: 10.1007/s11060-007-9404-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2007] [Accepted: 04/30/2007] [Indexed: 11/25/2022]
Abstract
We present a 68-year-old woman who presented with symptoms of frontotemporal dementia. Brain MRI revealed tumor mass in both thalami and according to WHO classification, the tumor corresponded to diffuse fibrillary astrocytoma grade II. This case points to the role of neuroimaging in patients presenting with classical symptoms of dementia.
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Affiliation(s)
- Mario Habek
- University Department of Neurology, Zagreb School of Medicine and University Hospital Center, Kispatićeva 12, 10000 Zagreb, Croatia.
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14
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Uchino M, Kitajima S, Miyazaki C, Shibata I, Miura M. Bilateral thalamic glioma--case report. Neurol Med Chir (Tokyo) 2002; 42:443-6. [PMID: 12416569 DOI: 10.2176/nmc.42.443] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 35-year-old woman presented with a bilateral thalamic glioma manifesting as dysesthesia over the left side of the body and mental deterioration. T1-weighted magnetic resonance imaging revealed enlarged bilateral thalami with homogeneous isointensity and no enhancement after gadolinium administration. Histological examination of a stereotactic biopsy specimen identified anaplastic astrocytoma. Radiotherapy and chemotherapy failed to arrest tumor growth. She subsequently died. Magnetic resonance imaging and clinical findings support the view that bilateral thalamic gliomas represent a distinct clinicopathologic entity among thalamic tumors.
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Affiliation(s)
- Masafumi Uchino
- Department of Neurosurgery, Toho University School of Medicine, Tokyo, Japan.
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