Glioma mimicking a hypertensive intracerebral hemorrhage

Abstract

Here, we report a rare case of an anaplastic astrocytoma masquerading as a hypertensive basal ganglia hemorrhage. A 69-year-old woman who had been under medical management for hypertension during the past 3 years suddenly developed right hemiparesis with dysarthria. Brain computed tomography (CT) scans with contrast and CT angiograms revealed an intracerebral hemorrhage (ICH) in the left basal ganglia, without an underlying lesion. She was treated conservatively, but underwent a ventriculoperitoneal shunt operation 3 months after the initial attack due to deteriorated mental status and chronic hydrocephalus. Three months later, her mental status deteriorated further. Magnetic resonance imaging (MRI) with gadolinium demonstrated an irregular enhanced mass in which the previous hemorrhage occurred. The final histological diagnosis which made by stereotactic biopsy was an anaplastic astrocytoma. In the present case, the diagnosis of a high grade glioma was delayed due to tumor bleeding mimicking hypertensive ICH. Thus, a careful review of neuroradiological images including MRI with a suspicion of tumor bleeding is needed even in the patients with past medical history of hypertension.

Keywords: Anaplastic astrocytoma; Basal ganglia; Brain tumor; Hypertension; Intracerebral hemorrhage; Tumor bleeding.

Fig. 1

Initial brain computed tomography (CT) demonstrates an intracerebral hemorrhage at the left basal ganglia, including the caudate nucleus (A). CT scan with contrast reveals no additional information about underlying pathology (B). Six weeks after discharge, follow-up CT scans demonstrates asymmetric ventriculomegaly and periventricular low density (C and D).

Fig. 2

Three months after the shunt operation, T1-weighted magnetic resonance images (A) with gadolinium (B) demonstrates an irregular, enhanced, round mass with multiple necrotic foci in the left basal ganglia, where the previous hemorrhage had occurred. A previous hematoma cavity is not visualized.