Presentation
Gait disturbance with behavioural impairment
Patient Data
The MRI sequences reveal bilateral thalamic mass, larger on the left thalamus. It appears of low signal intensity on T1WI, high signal intensity on FLAIR, and T2WI with a central area of very low signal on T1WI, and FLAIR, and high signal on T2WI. No surrounding oedema nor enhancement following IV contrast. A mass effect is noted on the midbrain and 3rd ventricle with obstructive bi-ventricular hydrocephalus. No calcification or haemorrhage within the mass on gradient echo.
MRS reveals an elevation of the choline as well as the choline/creatine, and choline/NAA ratios with myo-inositol spike.
Case Discussion
Bilateral thalamic gliomas are rare but considered as low-grade astrocytomas (World Health Organisation grade II). They occur in both children and young adults.
Despite the treatment, the prognosis is usually very poor due to the deep location of such tumours.
Additional contributor: A Ramdani MD
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