Glioma Mimicking a Hypertensive Intracerebral Hemorrhage
A 69-year-old woman visited our hospital presenting with nausea, vomiting, dysarthria, and right hemiparesis. The patient had been under medical treatment for hypertension for the previous 3 years. Brain computed tomography (CT) scans with contrast enhancement and CT angiograms demonstrated an acute intracerebral hematoma in the left basal ganglia, including the caudate nucleus, accompanied by a small amount of intraventricular hemorrhage, without any underlying enhanced lesion or vascular pathologies (). The patient was treated conservatively with anti-hypertensive drugs under a diagnosis of hypertensive basal ganglia ICH. Additional physical rehabilitation was performed, and the patient was discharged with improved motor function and mental status 6 weeks after admission. During follow-up as an outpatient, the patient was re-admitted for physical malaise and deteriorated mental status 6 weeks after discharge. Brain CT scans demonstrated asymmetric ventriculomegaly and low periventricular density (). Her mental status was temporarily improved and the ventricle size was decreased following a ventriculoperitoneal (VP) shunt operation. Three months after VP shunt placement, the patient's mental status deteriorated further and quadriparesis was noted. Brain magnetic resonance imaging (MRI) with gadolinium enhancement revealed an irregular, enhanced, round mass with multiple necrotic foci in the left basal ganglia, where the previous hemorrhage had occurred (). Navigation-assisted biopsy was performed, revealing an anaplastic astrocytoma (WHO grade III). The patient underwent radiotherapy, and repeat MR imaging revealed non-progression of the tumor (data not shown). However, she has been bed-ridden during 6 months of follow-up.