Bilateral thalamic and brainstem anaplastic astrocytoma: a case report

Background: Anaplastic astrocytoma (AA) is a diffusely infiltrating, high-grade glioma belonging to the primary central nervous system (CNS) neoplasm. Bilateral thalamic glioma (BTG) is extremely rare and characterized by strictly limited involvement of bilateral thalami. Here, we report a rare case of AA (WHO grade III astrocytoma) involving both thalami and the brainstem. Case presentation: A-33-year-old Chinese woman was referred to our department owing to persistent headache and nausea and vomiting. Neurological examination showed mild cognitive impairment and positive Kernig’s sign. Brain magnetic resonance imaging (MRI) demonstrated asymmetrical and swollen lesions involving both thalami, midbrain and pontine tegmentum, without restricted diffusion or enhancement. She was administrated with mannitol and glycerin fructose for decreasing intracranial pressure. In consideration of possible CNS tumor, the patient was transferred to the department of neurosurgery and underwent a stereotactic biopsy on day 7 after admission. Histopathological features and immunohistochemistry were consistent with AA, IDH wild-type, WHO grade III. In spite of receiving chemotherapy, she died on two-month after her initial diagnosis. Conclusions: : AA involving in both thalami and brainstem is rare entity with poor prognosis. The clinicians and radiologists should deepen their awareness of the specific MRI feature of bilateral thalamic involvement. When MRI alone is insufficient, the utility of stereotactic biopsy is essential for making a definitive diagnosis.