A glioma mimic which almost went under the knife
Shubham Dubey, Naveen P, Ayush Dubey- Psychiatry and Mental health
- Cellular and Molecular Neuroscience
- Geriatrics and Gerontology
- Neurology (clinical)
- Developmental Neuroscience
- Health Policy
- Epidemiology
Abstract
Background
There are many causes of acute dementia. While on one hand, it is essential to suspect a diagnosis based on clinical symptomatology and examination, radiological findings sometimes pose challenge leading to confusion regarding therapy being offered. An interesting case is discussed here.
Method
A female patient of age 39 years showed up in Neurology OPD with symptoms of forgetfulness, confusion, socially inappropriate behaviour and somnolence for around 15 days. There was no history of seizures, hallucinations or sensory symptoms. With a clinical diagnosis of acute dementia, she was subjected to brain imaging.
Result
Contrast enhanced brain MRI showed ill‐defined non enhancing T2 and FLAIR hyperintense lesion involving bilateral hypothalamus, adjoining antero‐inferior aspect of both thalami, bilateral medial basal ganglia & cavum septum in bilateral symmetrical fashion. There was no evidence of venous thrombosis and on the basis of above findings, a diagnosis of low grade glioma was considered and biopsy was planned. But, before going for invasive procedure, other possibilities were explored. With a suspicion of Wernicke’s encephalopathy, iv thiamine was tried with no benefit. Autoimmune workup showed positive NMDA receptor antibodies and hence, immunotherapy was tried to which, patient responded completely.
Conclusion
NMDA encephalitis can present with variable MRI findings. Thus, a possibility of this entity should always be considered in differentials for young female patients presenting with acute dementia like picture.