Gliomatosis cerebri angiographically mimicking central nervous system angiitis: case report.

Abstract

The diagnosis of isolated central nervous system angiitis often requires both cerebral angiography and biopsy for diagnosis. We present a case of gliomatosis cerebri with demonstrated angiographic changes suggestive of a central nervous system vasculitis. A 47-year-old woman presented with a 2-week history of worsening headache and progressive drowsiness. Magnetic resonance imaging scans revealed confluent nonenhancing T2-weighted hyperintensity involving the frontal white matter bilaterally, hypothalamus, and both thalami. A four-vessel angiogram revealed diffuse arterial beading with stenoses of a right frontal middle cerebral artery branch and the distal posterior cerebral artery and anterior cerebral artery branches, bilaterally. The biopsy revealed a Grade 2 fibrillary astrocytoma consistent with gliomatosis cerebri. Gliomatosis cerebri can mimic central nervous system vasculitis angiographically. Perivascular infiltration by tumor cells may be responsible for these changes.