CEREBRAL INFARCTION LINKED TO GERMINAL TUMOR

Objectives: Only rarely is the initial manifestation of a brain tumour a cerebral infarction (CI). Four cases have been documented in the adult population in which the cause of the CI was thought to be an incipient glioma, not yet visible on radiological examination.

Methods: An eleven year old patient presenting a two month history of left hemiparesis with left dystonic subacute hand posturing. MRI studies showed right pallidal ischemia with hemosiderin deposits (old lesion) and normal angioresonance. Stroke is ruled out after extensive studies, all negative. Patient starts physical and occupational therapy showing progressive improvement. Eleven months later, patient comes to consult over an episode of blurred vision, new MRI studies show no changes on angioresonance. At sixteen months, the patient present an episode of endocraneal hypertension, with worsening facial hemiparesis; brain MRI reveals an expansive 35mm image, with cystic areas on the right globus pallidum, spinal MRI studies were normal. Results: Tumoral resection showed the presence of a malignant CNS Germinal Tumour. Conclusion: Temporal proximity as well as same site for both lesions leads to the belief that the tumour, although not yet visible on radiological studies, has compressed or invaded a branch of the middle cerebral artery, thus originating the infarct.