| Identifier |
walsh_2013_s4_c4 |
| Title |
A Case of Mistaken Identity |
| Creator |
Lindsey B. De Lott, Patricia L. Robertson, Suresh K. Mukherji, Andrew P. Lieberman, Jonathan Daniel Trobe, MD, Michigan University |
| Subject |
High-grade glioma; Pilocytic astrocytoma; Magnetic resonance imaging |
| History |
A healthy 6-month old boy was sent to a pediatric neurologist because his parents had noted "irregular eye movements" for 1 month. The neurologist found horizontal nystagmus with a rare vertical component and ordered a brain MRI that demonstrated a suprasellar mass, prompting hospital admission. We found him to be alert and behaving normally. Vital signs and general physical examination were normal. He could fix and follow objects. Pupils reacted normally to bright light without afferent pupillary defect. He had a multivector nystagmus with rare intermittent convergence movements. Fundus and neurologic examinations were normal. Review of the outside brain MRI showed a mass perhaps arising from the diencephalon with high T2 signal and low T1 signal and intense enhancement. It compressed the third ventricle superiorly, extended anteriorly along the planum sphenoidale, and postero-inferiorly into the pre-pontine cistern. The imaging features, apparent site of origin, and the patient's young age strongly suggested a diagnosis of pilocytic astrocytoma. In view of the considerable risks in operating on such a young patient with such a large tumor, chemotherapy (carboplatin and vincristine) began without a tissue diagnosis. Four days later, the patient was readmitted for poor feeding and lassitude. Features of a dorsal midbrain syndrome were present. Brain CT demonstrated interval increase in the size of the lateral and third ventricles. A procedure was performed. |
| Pathology |
Microvascular proliferation, infiltrative growth, mitotic figures, areas of necrosis, and a MIB-1 proliferation index of 22%, characteristics of a high-grade glioma. |
| Disease/Diagnosis |
High-grade glioma |
| Clinical |
Horizontal nystagmus with a rare vertical component and ordered a brain MRI that demonstrated a suprasellar mass, prompting hospital admission. |
| Presenting Symptom |
A healthy 6-month old boy was sent to a pediatric neurologist because his parents had noted irregular eye movements for 1 month. |
| Neuroimaging |
MRI; CT Scan |
| Treatment |
Multi-Drug Chemotherapy |
| Date |
2013-02 |
| References |
1. Duffner PK, Cohen ME, Myers MH, Heise HW. Survival of children with brain tumors: SEER, 1973-1980. Neurology 1986;36(5):597-601. 2. Duffner PK, Krischer JP, Burger PC, et al. Treatment of infants with malignant gliomas: the Pediatric Oncology Group experience. J Neurooncol 1996;28(2-3):245-256. 3. Geyer JR. Infant brain tumors. Neurosurg Clin N Am 1992;3(4):781-789. 4. Duffner PK, Horowitz ME, Krischer JP, et al. Treatment of malignant brain tumors in infants and very young children: an update of the Pediatric Oncology Group experience. Neuro Oncol 1999;1(2) 152-161. 5. Kumar AJ, Leeds NE, Kumar VA, et al. Magnetic resonance imaging features of pilocytic astrocytoma of the brain mimicking high-grade gliomas. J Comput Assist Tomogr 2010; 34(4): 601-611. |
| Language |
eng |
| Format |
application/pdf |
| Type |
Text |
| Source |
45th Annual Frank Walsh Society Meeting |
| Relation is Part of |
Case presented at the NANOS 2013 Walsh Session, February 10 |
| Collection |
Neuro-Ophthalmology Virtual Education Library - Walsh Session Annual Meeting Archives https://novel.utah.edu/Walsh/index3.html |
| Publisher |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-6333 |
| Rights Management |
Copyright 2013. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6d8281h |
| Setname |
ehsl_novel_fbw |
| ID |
179148 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6d8281h |
