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Gliomatosis cerebri — Clinical Guidelines

Overview

Gliomatosis cerebri is a rare, infiltrative glial neoplasm characterized by diffuse infiltration of the brain parenchyma by neoplastic glial cells, predominantly oligodendroglial in nature, leading to progressive neurological deficits 7.

Diagnosis

Clinical presentation includes progressive neurological deterioration 7.

Imaging studies (CT, MRI) show diffuse infiltration of cerebral white matter, deep gray matter, and brain stem by neoplastic cells 7.

Lumbar puncture may reveal elevated intracranial pressure, though specific CSF findings are not typically highlighted in the literature provided.

Management

Discontinuation of any implicated medications (e.g., minocycline, vitamin A derivatives) 3 6 11.

Corticosteroids (e.g., dexamethasone) may be used to manage symptoms 8.

Surgical intervention might be considered in cases refractory to medical management, though specific recommendations are not detailed in the provided abstracts.

Special Populations

Pediatrics: Tetracyclines, particularly minocycline, can induce pseudotumor cerebri in children, necessitating careful monitoring and prompt discontinuation if symptoms arise 4 12.

Comorbidities: Conditions like hyperthyroidism and hypovitaminosis A can coexist with pseudotumor cerebri, potentially complicating diagnosis and management 10.

Key Recommendations

Discontinue any suspected offending medications (e.g., minocycline, vitamin A derivatives) immediately upon suspicion of drug-induced pseudotumor cerebri (Evidence: Moderate 3 6 11).

Consider corticosteroid therapy (e.g., dexamethasone) for symptom management in cases of drug-induced pseudotumor cerebri (Evidence: Weak 8).

Monitor pediatric patients closely for signs of pseudotumor cerebri when on tetracycline therapy, especially minocycline (Evidence: Expert opinion).

References

1 Angelette AL, Rando LL, Wadhwa RD, Barras AA, Delacroix BM, Talbot NC et al.. Tetracycline-, Doxycycline-, Minocycline-Induced Pseudotumor Cerebri and Esophageal Perforation. Advances in therapy 2023. link 2 Tibussek D, Distelmaier F, Kummer S, von Kries R, Mayatepek E. Sedation of children during measurement of CSF opening pressure: lack of standardisation in German children with pseudotumor cerebri. Klinische Padiatrie 2012. link 3 Mochizuki K, Takahashi T, Kano M, Terajima K, Hori N. Pseudotumor cerebri induced by minocycline therapy for acne vulgaris. Japanese journal of ophthalmology 2002. link00550-6) 4 Quinn AG, Singer SB, Buncic JR. Pediatric tetracycline-induced pseudotumor cerbri. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus 1999. link70095-9) 5 Chiu AM, Chuenkongkaew WL, Cornblath WT, Trobe JD, Digre KB, Dotan SA et al.. Minocycline treatment and pseudotumor cerebri syndrome. American journal of ophthalmology 1998. link00063-4) 6 Moskowitz Y, Leibowitz E, Ronen M, Aviel E. Pseudotumor cerebri induced by vitamin A combined with minocycline. Annals of ophthalmology 1993. link 7 Balko MG, Blisard KS, Samaha FJ. Oligodendroglial gliomatosis cerebri. Human pathology 1992. link90329-2) 8 Roytman M, Frumkin A, Bohn TG. Pseudotumor cerebri caused by isotretinoin. Cutis 1988. link 9 Pierog SH, Al-Salihi FL, Cinotti D. Pseudotumor cerebri--a complication of tetracycline treatment of acne. Journal of adolescent health care : official publication of the Society for Adolescent Medicine 1986. link80010-9) 10 Roos RA, van der Blij JF. Pseudotumor cerebri associated with hypovitaminosis A and hyperthyroidism. Developmental medicine and child neurology 1985. link 11 Spector RH, Carlisle J. Pseudotumor cerebri caused by a synthetic vitamin A preparation. Neurology 1984. link 12 Beran RG. Pseudotumour cerebri associated with minocycline therapy for acne. The Medical journal of Australia 1980. link 13 Gluckman J. Fungus cerebri--an unusual complication of mastoidectomy. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 1975. link

Gliomatosis cerebri