LEPTOMENINGEAL DISSEMINATION OF MALIGNANT GLIOMA SIMULATING CEREBRAL VASCULITIS - CASE-REPORT WITH ANGIOGRAPHIC AND PATHOLOGICAL-STUDIES

Background The complex clinical and radiological picture of leptomenin geal spread of tumor is well recognized as a problem of systemic cance r but is less frequent in primary cerebral glioma, particularly as a p resenting picture. While brain ischemia and infarction may occur in pa tients with subarachnoid tumor, the mechanism for these complications remains unclear. Angiographic and pathological demonstrations of direc t vascular involvement by disseminated glioma are particularly sparse. We report a patient presenting with multiple infarctlike lesions with postmortem evidence of direct vascular involvement by glioma. Case De scription A 54-year-old woman presenting with seizures, headache, and changes in mental status was found to have vascular narrowing in cereb ral blood vessels and ischemic lesions on neuroimaging studies of the brain, interpreted as cerebral vasculitis. A brain biopsy showed lepto meningeal glioma. Postmortem examination demonstrated a glioblastoma a rising around the right sylvian fissure with extensive subarachnoid di ssemination of tumor. The leptomeningeal tumor caused vascular narrowi ng by encasement, direct vascular wall invasion, and thrombosis and wa s associated with underlying infarctlike foci of parenchymal necrosis. Conclusions This case demonstrates an unusual presentation of gliobla stoma clinically and radiographically mimicking cerebral vasculitis, a nd it illustrates a variety of mechanisms for tumor-produced vascular compromise.