BILATERAL THALAMIC GLIOBLASTOMA MULTIFORME PRESENTING WITH APHASIA G Unis MD, E Philon DO Department of Medicine, Ochsner Medical Center, New Orleans, LA INTRODUCTION Bilateral thalamic lesions on brain Magnetic Resonance Imaging (MRI) represent a unique and unusual radiographic pattern. While unique, the differential for bilateral thalamic lesions is broad and can include cerebrovascular disease, toxin or metabolic syndromes, posterior reversible encephalopathy syndrome, viral infections, and neo- and paraneoplastic processes. CASE A 55-year-old male with hypertension and type 2 diabetes presented with an acute aphasia of 5 hours in duration and general malaise prior to admission but denied other significant symptoms. Physical examination at the time of admission was negative for neurological abnormalities including cranial nerve testing, as well as being fully alert and oriented with appropriate mentation. He was afebrile, slightly hypertensive with a blood pressure of 149/96, and without oxygen requirements. Laboratory studies were within normal limits on admission however, computed tomography of the head demonstrated subtle diminished density within the left thalamus. MRI imaging of the brain demonstrated bilateral thalamic enlargement with diffuse T2/FLAIR signal hyperintensity. Lumbar puncture was obtained and routine cerebral spinal fluid (CSF) studies in addition to viral, bacterial cultures, and autoimmune studies were ordered. The patient was found to be positive for West Nile Virus (WNV) but with a negative WNV polymerase chain reaction (PCR) and toxoplasmosis IgG positive results. The patient was treated empirically for toxoplasmosis but failed to improve. Repeat MRI was obtained and demonstrated new enhancement which prompted a brain biopsy of the temporal lobe. Pathology showed WHO Grade IV glioblastoma multiforme and the patient was referred to oncology. DISCUSSION This rare and unusual disease, while previously described in the literature highlights the broad differential for bilateral thalamic lesions found on brain MRI and represents a unique learning case.
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