Hemorragia cerebral espontânea como manifestação inicial de glioma multicêntrico / Spontaneous cerebral haemorrhage as an initial manifestation of multicentric glioma

Abstract

Introducao / Objetivos : Os gliomas multicentricos sao neoplasias malignas raras e importantes no diagnostico diferencial de lesoes cerebrais multiplas. Sao representados por lesoes multiplas, localizadas em lobos ou hemisferios cerebrais distintos, com ausencia de contiguidade entre as lesoes e de vias de disseminacao anatomica ou formacoes satelites. Apresentam manifestacao clinica heterogenea a depender da area cometida. A ressonância magnetica e o recurso utilizado para investigacao diagnostica, onde pode-se avaliar a ausencia de contiguidade entre as lesoes. O objetivo do presente estudo e relatar o caso de um paciente adulto portador de glioma multicentrico, cuja manifestacao inicial se deu apos episodio de hemorragia tumoral. Relato de caso : paciente masculino de 62 anos, sem diagnostico de lesao cerebral conhecida, foi diagnosticado com hemorragia cerebral espontânea. Apos algumas semanas, tal hemorragia revelou tratar-se de glioma multicentrico, confirmado por biopsia. Resultados: apos a biopsia, com a confirmacao do diagnostico, o paciente foi encaminhado para tratamento adjuvante. No entanto, faleceu por progressao da doenca. Conclusao : Os gliomas multicentricos sao raros e apresentam sintomatologia semelhante aos demais processos neoplasicos cerebrais, sendo que manifestacoes hemorragicas sao incomuns nesse tipo de neoplasia. Descritores : Glioma, Glioblastoma, Neoplasias encefalicas, Diagnostico por imagem Abstract Introduction / Purpose : Multicentric gliomas are rare malignant neoplasms and important in the differential diagnosis of multiple brain lesions. They are represented by multiple lesions, located in distinct lobes or cerebral hemispheres, with absence of contiguity between the lesions and of anatomical dissemination pathways or satellite formations. They present heterogeneous clinical manifestation depending on the committed area. Magnetic resonance imaging is the resource used for diagnostic investigation, in which the absence of contiguity between the lesions can be evaluated. The objective of this paper is to report the case of an adult patient with multicentric glioma, whose initial manifestation occurred after an episode of tumor hemorrhage. Case report : A 62-year-old male patient, without a known brain injury diagnosis, was diagnosed with spontaneous cerebral hemorrhage. After a few weeks, such bleeding revealed to be multicenter, biopsy-confirmed glioma. Results : After biopsy, with confirmation of diagnosis, the patient was referred for adjuvant treatment. However, he died of disease progression. Conclusion : Multicentric gliomas are rare and present similar symptomatology to other brain neoplastic processes, and hemorrhagic manifestations are uncommon in this type of neoplasia. Keywords : Glioma, Glioblastoma, Brain Neoplasms, Diagnostic Imaging