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Case 2

Infiltrating hyperintense changes with mass effect.

Involving gray and white matter.

Multiple lobes involved.

Ddx: Lymphoma, gliomatosis cerebri, multifocal glioma, demyelinating disease vs encephalitis.

Gliomatosis Cerebri

Diffusely infiltrating glial tumor.

Involving two or more lobes.

Frequently bilateral.

Infiltrates, enlarges yet preserves underlying brain architecture.

WHO grade III

Demographics:

Peak incidence: 40-50yo. Occurs at all ages.

No gender predominance.

Gliomatosis Cerebri

Clinical presentation:

Corticospinal tract deficits

HA

Seizures

Dementia

Gliomatosis Cerebri

Natural history and prognosis:

Relentless progression of disease.

Poor prognosis:

50% mortality @ 1 year.

75% mortality @ 3 years.

Mean survival of 38 months.

Gliomatosis Cerebri

Best diagnostic clue:

T2 hyperintense infiltrating mass with enlargement of involved structures.

Location:

Typically involves hemispheric WM, may also involve cortex.

Basal ganglia, thalami

Corpus collosum

Brainstem, spinal cord

Cerebellum

Gliomatosis Cerebri

CT findings:

Poorly defined asymmetric low density.

Loss of gray-white differentiation.

Expansion and mild mass effect.

May be normal in some cases.

Gliomatosis Cerebri

MR findings:

T1: Iso to hypointense infiltrating mass.

T2/FLAIR: Hyperintense homogeneous infiltrating mass, expansion/mass effect.

T1+C: Typically no or minimal enhancement.

DWI: Usually no restriction.