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Images in Neurology
March 2009

Diffuse Leptomeningeal Astrocytoma in a Patient With Infantile Epilepsy

Arch Neurol. 2009;66(3):408-409. doi:10.1001/archneurol.2008.574

A 29-year-old man was referred to us with a 2-week history of worsening headache, progressive visual loss, and increased frequency of seizures. At age 3 years, he had a severe general infection and subsequently developed obstructive hydrocephalus and complex focal epilepsy that was treated with a ventriculoperitoneal shunt and antiepileptic medication. He presented with severe visual loss due to optic nerve atrophy, cerebellar gait ataxia, and intention tremor. Magnetic resonance imaging disclosed a diffuse contrast-enhancing meningeal tumor mass surrounding the brain stem, in the posterior fossa, and along the spinal cord with additional cystic lesions in the cervical spinal cord. Interestingly, less pronounced meningeal tumor around the brainstem and cystic lesions in the spinal cord were already detected 3 years earlier. The cystic lesions in particular were almost unchanged (Figure, A).

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