The Wall-Eyed Potato Farmer

Young man presenting with apparent episodic neurologic evants that initially was thought to be multiple sclerosis, but as time went on, he had progressive changes in his neurologic exam and in his imaging findings. Brain biopsy revealed Gliomatosis cerebri. Anatomy: Brain Stem; Pons; Midbrain. Pathology: Diffuse infiltration of grey matter and white matter by glial cells. No endothelial proliferation or necrosis consistent with Gliomatosis cerebri. Disease/Diagnosis: Gliomatosis cerebri. Clinical Notes: 17 year old boy presented for evaluation of double vision. Examination showed bilateral internuclear ophthalmoplegia, and mild limitation of elevation. Patient had progression of his disease with new motor involvement of his 5th cranial nerves. Imaging: MR: Flare imaging abnormalities in the frontal temporal cortex which was progressive over time.