 |
Publisher: Peytchinski, Gospodin Iliev
ISSN: 1312 773X (Online)
Issue: 2015, vol. 21, issue 4
Subject Area: Medicine - Neurology
Pages: 908-913
Published online: 13 November 2015
J of IMAB 2015 Oct-Dec;21(4):908-913
RARE CLINICAL CASE OF GLIOBLASTOMA MULTIFORME, MULTIPLE SCLEROSIS AND EPILEPSY: CLINICAL, MRI AND 18F-FDG PET STUDY.
Ivan N. Dimitrov1
, Ara G. Kaprelyan2, Radoslav Georgiev3, Borislav D. Ivanov4, Yavor Enchev5, Тony Avramov5, Margarita V. Grudkova2, Nadezhda S. Deleva2,
1) Department of Nursing, Sliven Affiliate, Medical University - Varna, Bulgaria
2) Department of Neurology, Medical University - Varna, Bulgaria
3) Department of Imaging Diagnostics and Radiotherapy, Medical University - Varna, Bulgaria
4) Department of Clinical Medical Sciences, Faculty of Dental Medicine, Medical University - Varna, Bulgaria
5) Department of Neurosurgery and Otolaryngology, Medical University - Varna, Bulgaria.
ABSTRACT:
Background: The clinical features of multiple sclerosis during a relapse may raise the suspicion of a brain tumor as a possible differential diagnosis. Regardless of the high informative value of neuroimaging, some clinical cases remain challenging for neurologists, neurosurgeons and radiologists. Associations of brain tumors and relapsing-remitting multiple sclerosis have been described in the literature. Epilepsy, being common in brain tumors, is not among the most frequent and typical manifestations of multiple sclerosis, but both disorders appear together more commonly than by chance.
Objective: To present and discuss the diagnostic challenges in a case of coexisting epilepsy, multiple sclerosis, and glioblastoma multiforme.
Method: Case report.
Results: We present a 38-year-old patient with relapsing-remitting multiple sclerosis manifesting clinically a long period after a successfully treated epilepsy in childhood and adolescence. After reappearance of generalized tonic-clonic seizures and imaging evidence of a tumefactive lesion, the differential diagnosis between a new relapse and an initial manifestation of a brain was discussed. Glioblastoma multiforme was found intraoperatively.
Conclusion: Our case study demonstrates that the likelihood of parallel development of different pathological processes, such as demyelinating and neoplastic, in the same patient, should not be underestimated. We emphasize the critical importance of biopsy for the resolution of similar diagnostic dilemmas. Yet, obtaining consent for biopsy is not always a leading point in the communication with patients and their relatives. All efforts made for an accurate diagnosis are important, as properly chosen therapeutic options influence the prognosis.
Key words: 18F-FDG PET, Biopsy, Epilepsy, Glioblastoma, Multiple sclerosis,
- Download FULL TEXT /PDF 5356 KB/
Please cite this article in PubMed Style or AMA (American Medical Association) Style:
Dimitrov IN, Kaprelyan AG, Georgiev R, Ivanov BD, Enchev Y, Avramov T, Grudkova MV, Deleva NS. Rare Clinical Case of Glioblastoma Multiforme, Multiple Sclerosis and Epilepsy: Clinical, MRI and 18F-FDG PET Study. J of IMAB. 2015 Oct-Dec;21(4):908-913.
Correspondence to: Ivan Dimitrov, MD, PhD; First Clinic of Neurology, Sveta Marina University Hospital; 1, Hristo Smirnenski str., 9010 Varna, Bulgaria; E-mail: indimitrov@mail.bg
REFERENCES:
1. Erdem H, Stalberg E, Caglar I. Aphasia in multiple sclerosis. Ups J Med Sci. 2001; 106(3):205-210. [PubMed] [CrossRef]
2. Tavee JO, Bae CJ, Prayson RA, Pioro EP. A 25-year-old woman with hemiparesis and a solitary brain lesion. Cleve Clin J Med. 2002 May;69(5):389-394. [PubMed]
3. Navarro S, Mondejar-Marin B, Pedrosa-Guerrero A, Perez-Molina I, Garrido-Robres JA, Alvarez-Tejerina A. [Aphasia and parietal syndrome as the presenting symptoms of a demyelinating disease with pseudotumoral lesions]. [in Spanish] Rev Neurol. 2005 Nov;41(10):601-603. [PubMed]
4. Chebel S, Rekik O, Boughammoura-Bouatay A, Frih-Ayed M. [Pseudotumoral presentation of multiple sclerosis]. [in French] Neurochirurgie. 2007 Nov;53(5):379-382. [PubMed] [CrossRef]
5. Burgetova A, Seidl Z, Vaneckova M, Jakoubkova M. Concurrent occurrence of multiple sclerosis and primary CNS lymphoma: a case report. Neuro Endocrinol Lett. 2008 Dec;29(6):867-870. [PubMed]
6. Lucchinetti CF, Gavrilova RH, Metz I, Parisi JE, Scheithauer BW, Weigand S, et al. Clinical and radiographic spectrum of pathologically confirmed tumefactive multiple sclerosis. Brain. 2008 Jul;131(Pt 7):1759-1775. [PubMed] [CrossRef]
7. Costa MF, Novis SA, Niemeyer Filho P, Pimentel ML, Novis RF, Duarte F. [Multiple sclerosis, spinal cord ependymoma and intracranial meningioma: case report]. [in Portuguese] Arq Neuro-psiquiatr. 2000 Dec;58(4):1133-1137. [PubMed] [CrossRef]
8. Werneck LC, Scola RH, Arruda WO, Torres LF. Glioma and multiple sclerosis: case report. Arq Neuropsiquiatr. 2002 Jun;60(2-B):469-474. [PubMed] [CrossRef]
9. Acqui M, Caroli E, Di Stefano D, Ferrante L. Cerebral ependymoma in a patient with multiple sclerosis case report and critical review of the literature. Surg Neurol. 2008 Oct;70(4):414-420. [PubMed] [CrossRef]
10. Shuangshoti S, Hjardermaal GM, Ahmad Y, Arden JL, Herman MM. Concurrence of multiple sclerosis and intracranial glioma. Report of a case and review of the literature. Clin Neuropathol. 2003 Nov-Dec;22(6):304-308. [PubMed]
11. Kalimo H, Frey H, Raine CS, Torma T, Roytta M. Late-onset malignant astrocytoma in a case of multiple sclerosis. Clinical, neuropathological, virological, and tissue culture studies. Acta Neuropathol. 1979 May;46(3):231-234. [PubMed]
12. de la Lama A, Gomez PA, Boto GR, Lagares A, Ricoy JR, Alen JF, et al. Oligodendroglioma and multiple sclerosis. A case report. Neurocirugia (Astur). 2004 Aug;15(4):378-383. [PubMed]
13. Husseini L, Saleh A, Reifenberger G, Hartung HP, Kieseier BC. Inflammatory demyelinating brain lesions heralding primary CNS lymphoma. Can J Neurol Sci. 2012 Jan;39(1):6-10. [PubMed]
14. Lyons M, Patel N, Birch B, Boucher O. Central nervous system B-cell lymphoma in multiple sclerosis. Turk Neurosurg. 2012; 22(4):493-495. [PubMed] [CrossRef]
15. Yang JH, Wu SL. Multiple sclerosis preceding CNS lymphoma: a case report. Acta Neurol Taiwan. 2007 Jun;16(2):92-97. [PubMed]
16. Brecher K, Hochberg FH, Louis DN, de la Monte S, Riskind P. Case report of unusual leukoencephalopathy preceding primary CNS lymphoma. J Neurol Neurosurg Psychiatry. 1998 Dec;65(6):917-920. [PubMed] [CrossRef]
17. Hamasaki T, Yamada K, Kuratsu J. Seizures as a presenting symptom in neurosurgical patients: a retrospective single-institution analysis. Clin Neurol Neurosurg. 2013 Nov;115(11):2336-2340. [PubMed] [CrossRef]
18. Japp A, Gielen GH, Becker AJ. Recent aspects of classification and epidemiology of epilepsy-associated tumors. Epilepsia. 2013 Dec;54 Suppl 9:5-11. [PubMed] [CrossRef]
19. Allen AN, Seminog OO, Goldacre MJ. Association between multiple sclerosis and epilepsy: large population-based record-linkage studies. BMC Neurol. 2013 Dec 4;13:189. [PubMed] [CrossRef]
20. Durmus H, Kurtuncu M, Tuzun E, Pehlivan M, Akman-Demir G, Yapici Z, et al. Comparative clinical characteristics of early- and adult-onset multiple sclerosis patients with seizures. Acta Neurol Belg. 2013 Dec;113(4):421-426. [PubMed] [CrossRef]
21. Moreau T, Sochurkova D, Lemesle M, Madinier G, Billiar T, Giroud M, et al. Epilepsy in patients with multiple sclerosis: radiological-clinical correlations. Epilepsia. 1998 Aug;39(8):893-896. [PubMed] [CrossRef]
22. Nicholas R, Magliozzi R, Campbell G, Mahad D, Reynolds R. Temporal lobe cortical pathology and inhibitory GABA interneuron cell loss are associated with seizures in multiple sclerosis. Mult Scler. 2015 Apr. [Epub ahead of print] [PubMed] [CrossRef]
23. Uribe-San-Martin R, Ciampi-Diaz E, Suarez-Hernandez F, Vasquez-Torres M, Godoy-Fernandez J, Carcamo-Rodriguez C. Prevalence of epilepsy in a cohort of patients with multiple sclerosis. Seizure. 2014 Jan; 23(1):81-83. [PubMed] [CrossRef]
24. Poser CM, Brinar VV. Epilepsy and multiple sclerosis. Epilepsy Behav. 2003 Feb;4(1):6-12. [PubMed] [CrossRef]
25. Neelima R, Krishnakumar K, Nair MD, Kesavadas C, Hingwala DR, Radhakrishnan VV, et al. Tumefactive demyelinating lesions: a clinicopathological correlative study. Indian J Pathol Microbiol. 2012 Oct-Dec;55(4):496-500. [PubMed] [CrossRef].
Received: 01 September 2015
Published online: 13 November 2015