DIFFUSE LEPTOMENINGEAL GLIOMATOSIS ASSOCIATED WITH MULTIFOCAL CNS INFARCTS

BACKGROUND Widespread dissemination of astrocytoma throughout the cere brospinal fluid is unusual, especially as the initial presentation in a patient, and association with cerebral infarcts is rare. CASE DESCRI PTION A 47-year-old man subacutely developed progressive headache and backache, vomiting, altered consciousness, and numbness in both arms. Brain computerized axial tomography showed calcification in the fourth ventricle and magnetic resonance imaging demonstrated diffuse meninge al enhancement, a lesion in the canal of Magendie, and T2-weighted hyp erintense lesions in several locations. Angiography showed vasospasm/v asculopathy involving multiple cerebral vessels. Biopsy of the fourth ventricular mass revealed a subependymoma with an overlying leptomenin geal anaplastic astrocytoma with numerous Rosenthal fibers, The patien t was treated with three doses of intrathecal methotrexate via lumbar puncture but suddenly became unresponsive and died 6 days later, 8 wee ks after initial symptoms. Autopsy demonstrated the subependymoma and a widespread leptomeningeal anaplastic astrocytoma, which showed no cl earcut origin from the subependymoma, but microscopically infiltrated the left medial temporal lobe. Multiple subacute and acute infarcts of the brain, brain stem, and upper spinal cord were seen only in areas with leptomeningeal tumor. CONCLUSION Glioma cells surrounding and foc ally permeating central nervous system vessels without lumenal occlusi on can lead to vasospasm and widespread infarcts. (C) 1998 by Elsevier Science Inc.