[An autopsied case of medullary glioma with an abrupt onset of headache and hemiparesis].
We describe an 89-year-old woman who presented with an abrupt onset of headache and right hemiparesis. With the initial diagnosis of cerebral infarction, we started therapy using sodium ozagrel. The right hemiparesis worsened, however, and a continuous intravenous heparin injection showed no effect. Furthermore, nystagmus in the bilateral eyes, dysphagia, left hemiparesis, and central ventilation disorder appeared one after another in three weeks. A magnetic resonance images (MRI) of the head, performed on the fifth hospital day with regular intervals of axial sections, disclosed no lesion responsible for right hemiparesis. MRI of the brainstem and upper cervical cord, performed after two weeks with smaller intervals of axial sections, revealed a T2 high signal lesion in the left side of the medulla oblongata and upper cervical cord. After about five weeks from the onset of the disease, she died of pneumonia. With the pathological examination, we diagnosed as glioma originated in the left ventral part of medulla oblongata. Five similar cases of brainstem glioma have been reported so far. Our patient, the oldest one, showed an exceptionally rapid clinical course, instructing us to consider the possibility of medullary glioma even in the elderly patients presenting with acute onset hemiparesis followed by rapid and progressive appearance of brainstem signs.
Ishihara
Kenji
K
Department of Neurology, Ushioda General Hospital.
Shiota
Jun-ichi
J
Kawamura
Mitsuru
M
Nakano
Imaharu
I
D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000150:complications / Q000473:pathology*; D002544:Cerebral Infarction / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D005910:Glioma / Q000150:complications / Q000473:pathology*; D006261:Headache / Q000209:etiology*; D006801:Humans; D008526:Medulla Oblongata; D010291:Paresis / Q000209:etiology*