Infiltrative glial neoplasm mimicking acute ischemic stroke: the role of multiparametric magnetic resonance imaging. a case report

Abstract

Infiltrative gliomas can present as stroke mimics, simulating an acute ischemic stroke and complicating the initial diagnosis. We present the case of a 73-year-old woman with sudden onset of right hemiparesis. Magnetic resonance imaging (MRI) performed 24 hours after the onset of symptoms showed a left frontal cortico-subcortical lesion with restricted diffusion and no significant enhancement, findings initially interpreted as an ischemic event. However, persistent symptoms and radiological changes one month later, characterized by increased edema and the appearance of a subtle focus of enhancement, prompted a multiparametric MRI. Perfusion imaging demonstrated focal intralesional hyperperfusion (rCBV ≈ 3), while spectroscopy revealed increased choline, a relative decrease in N-acetylaspartate, and elevated myo-inositol, findings consistent with a probable infiltrative glial neoplasm. Due to the lesion's location in the dominant primary motor cortex, histopathological confirmation was not performed because of the high functional risk of the procedure. This case highlights the importance of reassessing the diagnosis when the clinical and radiological evolution is not compatible with the natural history of a cerebral infarction and underscores the value of multiparametric magnetic resonance imaging as a tool to guide the differential diagnosis of infiltrative glial lesions that present as stroke mimics.