A case of gliosarcoma appearing as ischaemic stroke.
OBJECTIVE
Ischaemic stroke attributable to malignant brain tumour is a rarely reported phenomenon and even various imaging techniques including angiography do not necessarily lead to an accurate diagnosis.


METHODS
A 46-year-old, previously healthy man developed apoplectic symptoms with slight right sided hemiparesis and global aphasia. The computed tomography (CT) scan showed lesions of the left temporal lobe and the paraventricular white matter suggestive of left middle cerebral artery (MCA) infarction. Carotid angiography demonstrated compression of the M1 segment of the MCA and occlusion of temporal MCA. The patient initially refused magnetic resonance imaging (MRI) because of claustrophobia. Because of fluctuating symptoms and successive worsening of the condition over weeks an MRI scan was conducted under general anaesthesia. Beneath temporal, opercular, and subcortical infarctions it revealed a left temporal tumour. A tumour biopsy disclosed a gliosarcoma (WHO grade IV). Microscopical examination of the surgical specimen demonstrated invasion of tumour cells into the wall of a greater pre-existing blood vessel.


CONCLUSIONS
Malignant brain tumours may cause ischaemic infarction. This is a rare but important differential diagnosis for the origin of strokes. The authors describe the first case with infiltration of intracranial blood vessels by tumour cells of a gliosarcoma.
Züchner
S
S
Department of Neurology, Aachen University Hospital, Aachen, Germany. stephen.zuechner@post.rwth-aachen.de
Kawohl
W
W
Sellhaus
B
B
Mull
M
M
Mayfrank
L
L
Kosinski
C M
CM
D002545:Brain Ischemia / Q000175:diagnosis*; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology* / Q000532:radiotherapy; D002533:Cerebral Angiography; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005904:Glial Fibrillary Acidic Protein; D018316:Gliosarcoma / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology* / Q000532:radiotherapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D014057:Tomography, X-Ray Computed
D005904:Glial Fibrillary Acidic Protein