Pseudo-subarachnoid hemorrhage and cortical visual impairment as the presenting sign of gliomatosis cerebri

Abstract

A 49-year-old white male presented with a pseudo-subarachnoid hemorrhage and diffuse brain edema. Neuroimaging showed brain edema causing the unusual findings of a pseudo-subarachnoid hemorrhage and bilateral occipital lobe infarcts following herniation and compression of the posterior cerebral arteries. An enlarged corpus callosum was noted which led to a brain biopsy and a diagnosis of gliomatosis cerebri.

Pseudo-Subarachnoid Hemorrhage Found in Patients with Postresuscitation Encephalopathy: Characteristics of CT Findings and Clinical Importance

“…Several investigators have reported that head CT images of such patients sometimes show high-attenuation areas (HDAs) along the cisterns or cortical sulci, mimicking subarachnoid hemorrhage (SAH), which was ruled out at autopsy or after a lumbar puncture and CSF examination. [1][2][3][4][5][6][7][8][9][10][11][12] These SAH-like findings were first described by Spiegel et al in 1986. 1 They reported that 10 patients with marked brain edema associated with a brain tumor or cerebral infarction showed SAH-like HDAs along the interhemispheric fissure and tentorium cerebelli on CT; in all 10 patients, intracranial hemorrhage was ruled out at autopsy.…”

Pseudo-subarachnoid hemorrhage in cerebellar infarction

“…Misdiagnoses of SAH based on CT appearance have been reported with intrathecal contrast agents, diffuse cerebral edema, purulent or viral meningitis [1], bilateral subdural hematomas, spontaneous intracranial hypotension [2], septic shock, cerebral vasculitis [1], idiopathic intracranial hypertension [1], and gliomatosis cerebri [3]. There are several theories explaining the misleading CT appearance of blood in the absence of SAH including calcification of dural structures or blood vessels, volume averaging, presence of purulent substance, displacement of hypodense CSF [4], cerebral venous congestion and engorgement, impaired dural vascular supply, or relative high density of extra-axial structures compared to the hypodense appearance of diffusely injured brain [1].…”

Bilateral Ptosis as Initial Presentation of Gliomatosis Cerebri: Case Report

“…A parkinsonian-like syndrome to pseudosubarachnoid hemorrhage with eventual cortical blindness has been described. 5, 6 Dexter et al described the case of a 16-year-old girl who presented with a right-sided, pupil-sparing third nerve palsy who was noted to have focal areas of nonenhancing cortical thickening in the right frontal lobe and insula that was thought to represent polymicrogyria. The white matter was spared.…”

“…4 Clinical presentations of gliomatosis cerebri may be similar to other gliomas or may vary from a parkinsonian-like syndrome to pseudosubarachnoid hemorrhage with eventual cortical blindness. 5,6 At times, the diagnosis may be missed and only confirmed postmortem, and there is no standardized treatment strategy for this entity. 1,7 Adjuvant chemotherapy following radiotherapy may prolong survival in these patients, and the appearance of new contrast-enhancing lesions on MRI may suggest progression of gliomatosis cerebri.…”