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Table of Contents
LETTER TO EDITOR
Year : 2020  |  Volume : 3  |  Issue : 3  |  Page : 97-98

Primary bilateral thalamic glioma with bipeduncle involvement of midbrain


1 Department of Neurosurgery, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab, India
2 Department of Anaesthesia, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab, India
3 Department of Radiology, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab, India

Date of Submission07-Jul-2020
Date of Decision08-Jul-2020
Date of Acceptance09-Jul-2020
Date of Web Publication26-Aug-2020

Correspondence Address:
Dr. Paramdeep Singh
Department of Radiology, Guru Gobind Singh Medical College and Hospital, Baba Farid University of Health Sciences, Faridkot, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/VIT.VIT_22_20

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How to cite this article:
Aggarwal V, Narang A, Maheshwari C, Singh P. Primary bilateral thalamic glioma with bipeduncle involvement of midbrain. Vasc Invest Ther 2020;3:97-8

How to cite this URL:
Aggarwal V, Narang A, Maheshwari C, Singh P. Primary bilateral thalamic glioma with bipeduncle involvement of midbrain. Vasc Invest Ther [serial online] 2020 [cited 2020 Oct 28];3:97-8. Available from: https://www.vitonline.org/text.asp?2020/3/3/97/293526



Dear Editor,

Bilateral thalamic tumors are very rare. The natural history, management, and prognosis of primary bilateral thalamic glioma are different from unilateral thalamic glioma. According to some case reports, the prognosis of bilateral thalamic glioma is poorer. The origin of bilateral thalamic glioma is uncertain. According to one theory, one-sided thalamic nuclei glioma spreads to the other side with time, while, according to another theory, tumors arise from the subependymal region of the third ventricle.[1],[2] A 26-year-old male presented with headache and vomiting for 2 months with altered sensorium for 1 day. On examination, the patient had bilateral papilledema, right 6th CN paresis, and bradycardia. Magnetic resonance imaging of the brain revealed bilateral thalamic lesion, which extended up to the hypothalamus and peduncle of the midbrain. The lesion was isointense on T1-weighted image, Hyperintense on T2 and fluid-attenuated inversion recovery images, and not enhancing on Gd T1 image [Figure 1]. The patient underwent biopsy with septostomy and ventriculoperitoneal shunt. The incidence of primary thalamic tumors is 0.84%–5.2% of all intracranial tumors and 25% of them occur in children aged <15 years.[3] In available data, only case reports are there in the literature. Primary bilateral thalamic glioma has been found to respect the gray-white matter border for an extended period, unlike other gliomas that widely spread through white matter fiber.[4] However, in our case, there was the infiltration of midbrain and hypothalamus. This may suggest that in initial stages, bilateral thalamic gliomas respect the gray-white matter border, but in later stages, they may become infiltrating and diffuse along the fibers.
Figure 1: (a and b) Magnetic resonance imaging T2-weighted image showing bilateral thalamic glioma. (c) Fluid-attenuated inversion recovery image showing the involvement of midbrain and cerebral peduncles. (d) Magnetic resonance imaging T2 weighted coronal image showing the involvement of bilateral thalamus and bilateral mammillary bodies. (e) Magnetic resonance imaging T2-weighted coronal image showing involvement midbrain and cerebral peduncles. (f) Magnetic resonance imaging T2-weighted sagittal image showing involvement midbrain and cerebral peduncles

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Estève F, Grand S, Rubin C, Hoffmann D, Pasquier B, Graveron-Demilly D, et al. MR spectroscopy of bilateral thalamic gliomas. AJNR Am J Neuroradiol 1999;20:876-81.  Back to cited text no. 1
    
2.
Hirano H, Yokoyama S, Nakayama M, Nagata S, Kuratsu J. Bilateral thalamic glioma: Case report. Neuroradiology 2000;42:732-4.  Back to cited text no. 2
    
3.
Reardon DA, Gajjar A, Sanford RA, Heideman RL, Walter AW, Thompson SJ, et al. Bithalamic involvement predicts poor outcome among children with thalamic glial tumors. Pediatr Neurosurg 1998;29:29-35.  Back to cited text no. 3
    
4.
Menon G, Nair S, Sudhir J, Rao BR, Krishnakumar K. Bilateral thalamic lesions. Br J Neurosurg 2010;24:566-71.  Back to cited text no. 4
    


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