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Cerebral gliomatosis, a rare cause of diffuse brain infiltration Volume 6, issue 6, November-December 2020

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Authors
1 Université Sidi Mohamed ben Abdellah de Fès
Faculté de médecine et de pharmacie
Département de biophysique et de méthodes cliniques d’IRM
Route Sidi Hrazem, Km 2.2
30000 Fès
Maroc
2 Université Sidi Mohamed ben Abdellah de Fès
Faculté de médecine et de pharmacie
Laboratoire de neurosciences cliniques
Route Sidi Hrazem, Km 2.2
30000 Fès
Maroc
3 Hôpital universitaire de Fès
Département de radiologie et d’imagerie clinique
Route Sidi Hrazem, Km 2.2
30000 Fès
Maroc
* Tirés à part

Cerebral gliomatosis (CG) is a rare tumour presenting with a diffuse infiltration of neoplastic glial cells in the brain. Diagnosis is often difficult since both clinical and imaging results are non-specific.

We studied a case of CG that occurred in a 45-year-old woman, who consulted for intermittent headaches and memory and walking difficulties. The neurological examination revealed tetrapyramidal syndrome and paresis of the four limbs, associated with static and kinetic cerebellar syndrome. The biological assessment was normal. Brain MRI showed a tentorial diffuse infiltrating lesion, appearing as a hypersignal on FLAIR. Magnetic resonance spectroscopy revealed a tumoral pathology with raised choline, decreased NAA, and an absence of lipids. The peak of myoinositol was indicative of a low-grade glial tumour. The diagnosis of cerebral gliomatosis was made. The patient received temozolomide chemotherapy, with initially good clinical results, reflected by a regression of neurological disorders. Fourteen months later, the patient was admitted with impaired consciousness and died following involvement of the temporal area and amygdala.

CG should be considered when presented with a diffuse encephalic infiltration involving at least two adjoining cerebral lobes. MRI coupled with MR spectroscopy allows diagnosis to be reached and ensures adequate follow-up. The prognosis in such cases remains unclear, despite adequate treatment.