Primary diffuse leptomeningeal gliomatosis simulating tuberculous meningitis

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 70; no. 1; pp. 120 - 122
• Main Authors: Rees, J H, Balakas, N, Agathonikou, A, Hain, S F, Giovanonni, G, Panayiotopoulos, C P, Luxsuwong, M, Revesz, T
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.01.2001; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Adult; Antitubercular agents; Bacterial diseases; Biological and medical sciences; Cellular biology; Chemotherapy; Evaluation; Female; Glioma - diagnosis; Glioma - diagnostic imaging; Gliomas; gliomatosis; Glucose; Headaches; Human bacterial diseases; Humans; Hydrocephalus; Infections; Infectious diseases; leptomeningeal; Lymphocytes; Male; Medical sciences; Meningeal Neoplasms - diagnosis; Meningeal Neoplasms - diagnostic imaging; Meningitis; Middle Aged; Neck; Neurology; Proteins; Short Report; Spinal cord; Tomography, Emission-Computed, Single-Photon; Tuberculosis and atypical mycobacterial infections; Tuberculosis, Meningeal - diagnosis; Tuberculosis, Meningeal - diagnostic imaging; Tuberculous meningitis; Tumors; Tumors of the nervous system. Phacomatoses; United States; Radionuclide study; Human; Nervous system diseases; Cytology; Mycobacterial infection; Cerebrospinal fluid; Differential diagnostic; Cerebral disorder; Communicating hydrocephaly; Infection; Case study; Tuberculosis; Glioma; Central nervous system disease; Primary; Bacteriosis; Tumor; Leptomeninge; Meningitis; Positron; Emission tomography
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.70.1.120

Three patients are reported on who presented with communicating hydrocephalus due to presumed tuberculous meningitis. Subsequent clinical deterioration despite antituberculous chemotherapy prompted reassessment with FDG-PET scanning and meningeal biopsy in one case and repeat CSF cytology with special staining in the second. The third patient died and postmortem confirmed a diagnosis of primary diffuse leptomeningeal gliomatosis. In the first two patients, MRI of the entire neuraxis showed no evidence of a primary intraparenchymal tumour. These cases emphasise the need for repeated reassessment in patients with culture negative lymphocytic meningitis. In addition, this is the first report of FDG-PET scanning in leptomeningeal gliomatosis.