title: Diffuse leptomeningeal gliomatosis initially presenting with intraventricular hemorrhage: a case report and literature review.
abstract: BACKGROUND
  Primary diffuse leptomeningeal gliomatosis (PDLG) is a lethal neoplasm that is characterized by glioma cells exclusively infiltrating into cerebral and spinal meninges. Intraventricular hemorrhage as an initial symptom in PDLG patient has not been reported in the literatures.
  
  
  METHODS
  A 39-year-old man initially presented with intraventricular hemorrhage. The patient had an improved outcome at the early stage of hemorrhagic course; however, the clinical condition began to a sudden turn for deterioration with intracranial hypertension and cerebral hernia on day 15 after admission. Cerebral CT and MRI showed diffuse patchy signals with enhancement in bilateral cerebellopontine angle cistern, suprasellar cistern, ambient cistern, quadrigeminal cistern, bilateral cerebellum, cerebral hemisphere, and upper cervical cord surface. Pathological examination revealed that numerous spindled cells were scant of cytoplasm with hyperchromatic nuclei and various mitotic figures. Immunohistochemistry showed that the cells were positive to glial fibrillary acidic protein (GFAP) with about 5% Ki-67 positive labeling. The pathological findings were consistent with the diagnostic criteria of anaplastic astrocytoma (WHO grade III).
  
  
  CONCLUSIONS
  We reported an interesting case that PDLG initially presented with intraventricular hemorrhage that might be caused by astrocytoma rupturing into pial vessels.
authors.affiliation: Department of Neurology, The First Affiliated Hospital of Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, P.R. China. zhumin1@126.com.
authors.forename: Min
authors.initials: M
authors.lastname: Zhu
authors.affiliation: Department of Neurology, The First Affiliated Hospital of Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, P.R. China. zjj259@163.com.
authors.forename: JunJun
authors.initials: J
authors.lastname: Zheng
authors.affiliation: Department of Neurology, The First Affiliated Hospital of Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, P.R. China. 846366855@qq.com.
authors.forename: Yuanzhao
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Neurology, The First Affiliated Hospital of Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, P.R. China. ncwanhui@sina.com.
authors.forename: Hui
authors.initials: H
authors.lastname: Wan
authors.affiliation: Department of Neurology, The First Affiliated Hospital of Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, P.R. China. wuyuchen52@163.com.
authors.forename: Yuchen
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Department of Neurology, The First Affiliated Hospital of Nanchang University, Yong Wai Zheng Street 17#, Nanchang, 330006, P.R. China. hongdaojun@hotmail.com.
authors.forename: Daojun
authors.initials: D
authors.lastname: Hong
mesh_terms: D000328:Adult; D001254:Astrocytoma / Q000175:diagnosis / Q000473:pathology; D001921:Brain / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000209:etiology; D005910:Glioma / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D008578:Meninges / Q000473:pathology; D018302:Neoplasms, Neuroepithelial / Q000175:diagnosis* / Q000473:pathology; D013116:Spinal Cord / Q000473:pathology