Article
Third-nerve palsy caused by primary leptomeningeal gliomatosis in a two-year-old child
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Published: | September 22, 2004 |
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Outline
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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.