Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Leptomeningeal gliomatosis with high levels of adenosine deaminase in the cerebrospinal fluid

Hideaki Nishihara, M.D.1), Masatoshi Omoto, M.D.1), Jun-ichi Ogasawara, M.D.1), Michiaki Koga, M.D.1), Motoharu Kawai, M.D.1) and Takashi Kanda, M.D.1)

1)Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine

A 61-year-old man developed disturbance of consciousness for 2 weeks. He showed neck stiffness and hyporeflexia. Analysis of his cerebrospinal fluid (CSF) revealed pleocytosis and markedly reduced glucose contents. Adenosine deaminase (ADA) levels in the CSF were elevated (28.8 IU/l). Brain magnetic resonance imagings showed enhancement of the leptomeninges. Tuberculous meningitis was considered, but antituberculous drug was not effective. Repeated cytological analysis of the CSF demonstrated atypical cells with enlarged unevenly distributed nuclei and immunoreactive with glial fibrillary acidic protein. We diagnosed him as leptomeningeal gliomatosis. CSF ADA may be elevated in this rare disorder, and here we emphasize that repeated cytological analysis with immunohistochemical staining was useful for diagnosis.
Full Text of this Article in Japanese PDF (22855K)

(CLINICA NEUROL, 54: 308|312, 2014)
key words: adenosine deaminase, astrocytoma, leptomeningeal gliomatosis

(Received: 2-Mar-13)