Bilateral thalamic glioma
Gait disturbance with behavioural impairment
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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 edema nor enhancement following IV contrast. A mass effect is noted on the midbrain and 3rd ventricle with obstructive bi-ventricular hydrocephalus. No calcification or hemorrhage 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.
Despite the treatment, the prognosis is usually very poor due to the deep location of such tumors.
Additional contributor: A Ramdani MD