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Título

Anaplastic astrocytoma causing rapidly progressive dementia - a case report

RESUMO

Case report: Patient M.B.S., 50 years old, male, hypertensive. Two months ago he started with memory and executive function alterations, with an impact on his functionality and his work. In addition, with severe left hemicranial headache, stabbing type, lasting 2 minutes, intermittent, without photophobia, phonophobia, nausea or vomiting. After 2 months, he presented with seizure of unknown onset with evolution to generalized tonic-clonic, without associated fever. No weight loss. Physical examination revealed mixed aphasia of motor predominance, with phonemic paraphasia and agraphia. No change in strength, sensitivity or coordination. Cranial resonance with T2/FLAIR hypersignal affecting the caudate nucleus, putamen, globus pallidus, hippocampus and left insula, as well as cortical surface of the frontal and homolateral parietal regions, with mass effect, without DWI restriction and without gadolinium enhancement. Ascopy with choline peak and n-acetyl-aspartate reduction. Biopsy showed grade III anaplastic astrocytoma. Descompressive craniectomy and radiotherapy were performed. Discussion: Analyses of the global disease burden have shown that 43.8 million people lived with dementia. Assuming that a substantial percentage of these patients presented with rapidly progressive dementias (RPD), it is evident the importance to consider superimposed reversible conditions in the differential diagnosis of RPD.Besides paraneoplastic immunemediated encephalopathies, primary CNS neoplasias are also potential causes of RPD. These neoplasias can affect cortical and subcortical structures through space occupation, infiltration and destruction of brain tissue, secondary edema or disturbance of CSF circulation resulting in intracranial hypertension. However, treatment options that prolong survival and might improve cognitive performance are becoming available. Final coments: In RPD, the chances of treatment success are better the earlier the diagnosis is made. Mainly when potentially treatable pathologies are identified.

Palavras Chave

Dementia;Astrocytoma;