Case of the month July 2006 Boxer, m, 10y. 8 hours ago sudden onset of hindlimb paresis; still able to walk but lurching and swaying then toppling down,

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Presentation transcript:

Case of the month July 2006 Boxer, m, 10y

8 hours ago sudden onset of hindlimb paresis; still able to walk but lurching and swaying then toppling down, losing urine and unable to walk History

Referral to Neurology division of the Vetsuisse Faculty University Berne Results of neurologic exam Somnolence Tetraparesis with normal spinal reflexes Reduced menace response left; right side absent Reduced face sensitivity on the right  MRI of the head

FSE T2-weighting transverse dorsal right Level of caudate nucleus (c)Level of thalamus (t) tt c c

FLAIR (CSF suppression) dor rostral right rostral BASG dor

FE 3D T1 MPR dorsal 1mm slice thickness plain+C rostral right

findings ?

A large space-occupying lesion, slightly hyperintense to grey matter in T2, BASG and T1, markedly hyperintense in FLAIR and without contrast uptake is seen in the left forebrain. It involves both lateral ventricles and appears well delineated from CSF.

Interpretation The lesion is consistent with an intraaxial neoplasia invading the ventricles; most likely a glioma. Comment Aggressive gliomas usually show no contrast uptake. Unusual in this case was the involvement of the lateral ventricles. The CSF (bright in T2 and BASG, dark in FLAIR and T1) was reduced in volume, but showed normal signal behaviour in all sequences. It could be well delineated from the surface of the tumour.