Clinical History
One year history of seizures and dizziness. Previously treated by antiepileptic drug therapy, but showed no response.
Imaging Findings
The patient presented with one year history of seizures and dizziness was admitted to the hospital for further evaluation. Previously he was treated by antiepileptic drug therapy, but showed no response. Physical and neurological examination at admission revealed no pertinent information. MRI of the brain was performed.
Based on clinical and MR imaging findings a tumor was suspected. After complete surgical removal of the tumor, radiation therapy was applied. Histological examination of the resected specimen disclosed a well-differentiated ganglioglioma.
Discussion
Ganglioglioma is a rare primary tumor of the brain. According to recent studies it accounts for 0.4-7.6% of all intracranial tumors in children and up to 1.3% of intracranial tumors in adults.
The term ganglioglioma was introduced by Perkins in 1926. Histologically the tumor consists of glial elements and differentiated nerve cells. It is a relatively low graded tumor. Malignant degeneration or metastasis are very rare. Approximately 40% of gangliogliomas have cystic components. According to the WHO-classification the biological behavior of ganglioglioma is comparable to astrocytoma grade II.
Ganglioglioma occurs at any location in the brain, but predilection sites are the temporal lobe and the floor of the third ventricle. Clinically it manifests with seizures, dizziness, medically intractable epilepsy, and less commonly focal neurological deficits.
MR features of ganglioglioma are not specific. The solid part of the tumor is isointense on T1-weighted images, slightly hyperintense on T2-weighted images, and of very high signal intensity on proton density images.
The cystic components of the tumor are hypointense on T1-weighted images and markedly hyperintense on T2-weighted images. Calcifications, seen as signal voids, are not well appreciated on standard spin echo sequences, but they may be visible on CT scan. The differential diagnosis includes juvenile pilocytic astrocytoma, pleomorphic xanthoastrocytoma and gangliocytoma.
Differential Diagnosis List
Intracranial ganglioglioma
Final Diagnosis
Intracranial ganglioglioma
