diagnosis reported as 3 years in patients with grade II BLTG (2,10).We present the case of a BLTG manifesting with fast progressive cognitive dysfunction leading to dementia in an elderly patient.
█ CASE REpORTA 72-year-old right handed male, treated only for essential arterial hypertension stage I, presented 3 months prior to admittance, with gradual deterioration of the cognitive functions and intermittently aggressive behavior towards close relatives. The symptoms progressed gradually, with the patient not being able to perform basic everyday tasks and presenting periods of extreme agitation.
█ INTRODUCTIONPrimary thalamic gliomas are rare and have been presented in recent reports with an incidence of 0.84-5.2% among all intracranial tumors (2,4,15,18).Bilateral thalamic gliomas (BLTG) constitute a unique intracranial tumoral pathology typically manifested by varying degrees of personality disorder. The rate of BLTG is much lower than that of unilateral thalamic glioma and cannot be objectively expressed in any way at present (4-7,13).Imaging in BLTG is typical and reveals large tumors with symmetrical and strictly limited involvement of bilateral thalami, without any apparent connecting tumoral tissue (2).The prognosis of BLTG is poor and a rapid fatal evolution has been observed (14) with the longest period of survival after the Bilateral thalamic glioma is extremely rare and the incidence cannot be adequately expressed. We present the case of a 72 years old male suffering from the rapid deterioration of cognitive function to moderately severe dementia in a short period of time. Magnetic resonance studies demonstrated a bilateral thalamic glioma with a minimal focal gadolinium uptake in the left thalamus. Biopsy was performed and pathology report was of anaplastic astrocytoma, WHO grade III. Radiotherapy was proposed but was rejected by the patient's relatives. The patient deceased 57 days later. We performed an extensive review of the literature and by updating the previous described series we can state that to the best of our knowledge this is the 60th case described in the literature and the second eldest patient presented. Patients suffering from this disease present a poor prognosis, the longest survival described being of 3 years in patients diagnosed with grade II bilateral thalamic glioma. Adjuvant therapy in form of radiotherapy to the thalami is most commonly used but the benefits are unclear. The natural progression of WHO grade III bilateral thalamic glioma left untreated, as can be seen from our case, has an even poorer outcome.
