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Images in Neurology
December 2008

Bilateral Thalamic Glioma

Arch Neurol. 2008;65(12):1666-1667. doi:10.1001/archneur.65.12.1666

A 56-year-old woman was admitted to the hospital with new onset of tonic-clonic seizures. She had no significant medical or drug history. Results of the physical examination were normal, with no neurocognitive impairment. Her white blood cell count was 12 200/μL (to convert to × 109/L, multiply by 0.001), and her neutrophil count was 10 200/μL (to convert to × 109/L, multiply by 0.001). Magnetic resonance (MR) imaging demonstrated homogeneous asymmetrical swelling and enlargement of both thalami with distortion of both lateral ventricles. The thalamic lesions were isointense on T1-weighted images (Figure 1A) and hyperintense on T2-weighted images (Figure 1B) and fluid attenuation inversion recovery images (Figure 1C), with no enhancement after contrast administration. Magnetic resonance spectroscopy of the tumor revealed increased myo-inositol levels, diminished N-acetyl aspartate levels, and an increased creatine peak with an elevated creatine to choline ratio (Figure 2). A radiological diagnosis of bithalamic glioma was made. A stereotactic biopsy confirmed bilateral grade II astrocytomas. The patient was treated with dexamethasone, valproate sodium, and radiotherapy. She remained seizure free at the last follow-up visit.

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