Abstract
Demyelinating diseases of the brain may show mass effects and/or contrast enhancement on CT scans, simulating the appearance of infiltrating glioma.
A 36-year-old male, had suffered from gait disturbance and convulsive attacks involving the right lower limb since the age of 30. He had gradually developed character changes and urine incontinence. Six months prior to admission he experienced several attacks of generalized convulsions. On admission, he showed a mild hemiparesis, bilateral Babinski signs, and ataxic gait. He was disoriented and had memory disturbance and moria. CT scan showed low density areas in the bilateral frontal lobes and corpus callosum associated with a mild mass effect. Contrast study revealed irregular enhancement along the edge of the low density area and another small enhancing lesion in the left temporal lobe. This CT finding was interpreted as that of “butterfly” glioma. Craniotomy and right frontal lobectomy were performed. Histological study, however, demonstrated demyelination in the white matter associated with perivascular proliferation of lymphocytes. The final diagnosis was the ‘transitional sclerosis’ of Poser.
