gms | German Medical Science

102. Jahrestagung der DOG

Deutsche Ophthalmologische Gesellschaft e. V.

23. bis 26.09.2004, Berlin

Third-nerve palsy caused by primary leptomeningeal gliomatosis in a two-year-old child

Meeting Abstract

  • corresponding author J. S. Karp - Augenklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • J. A. Reichelt - Augenklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • A. Claviez - Kinderklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • K. Klöpper - Kinderklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • O. Jansen - Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • O. D. Wiestler - Neuropathologie, Universität Bonn
  • J. Roider - Augenklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel

Evidenzbasierte Medizin - Anspruch und Wirklichkeit. 102. Jahrestagung der Deutschen Ophthalmologischen Gesellschaft. Berlin, 23.-26.09.2004. Düsseldorf, Köln: German Medical Science; 2004. Doc04dogP 112

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Veröffentlicht: 22. September 2004

© 2004 Karp et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective

There are miscellaneous uncommon causes for third nerve palsy in a child. A case of a two-year-old child with third nerve palsy as one of the first symptoms caused by primary leptomeningeal gliomatosis (PLG), is presented. This is the youngest patient with this rare tumor, that has been reported.

Results

The child was admitted after the parents had noticed an intermittent abduction of the right eye, drowsiness and vomiting. Initial examination revealed no disorder of eye movement and normal optic discs. MRI of the brain demonstrated ventricular enlargement and enhancement of the meninges. Multiple examinations of the cerebrospinal fluid after lumbar puncture showed slight pleocytosis and increased protein concentration. Tumorcells were not found at any time. The patient had several seizures and underwent placement of a ventriculoperitoneal shunt for hydrocephalus. MRI of the spine showed an intradural extramedullar process with abnormal enhancement, as seen before in MRI of the brain. By biopsy of this region the diagnosis of an astrocytoma grade I with PLG was made. Because of bilateral third nerve palsy alternate occlusion was started. Chemotherapy according to the study group HIT-LGG 2003 is administered.

Conclusions

We believe the bilateral third nerve palsy to be caused directly by the tumor. Diagnosis of the rare disease PLG is possible by gradolinium enhanced MRI of the brain and the spine and by biopsy. To our knowledge this is the youngest patient with PLG reported.