Case Report Primary Diffuse Leptomeningeal Gliomatosis: Radiological/Pathological Features Ehtasham Ahmad, 1 Mohamed Mohamed, 1 and Apostolos Vrettos 1,2 1 East Kent Hospitals University NHS Trust, Queen Elizabeth the Queen Mother Hospital, Department of General Internal Medicine, Margate, UK 2 Teesside University, School of Health & Social Care, Middlesbrough, UK Correspondence should be addressed to Ehtasham Ahmad; ehtasham999@hotmail.com Received 25 August 2016; Revised 11 October 2016; Accepted 26 October 2016 Academic Editor: Xue Ming Copyright © 2016 Ehtasham Ahmad et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. We present the case of a 43-year-old lady who presented with headaches, visual impairment, and seizures, progressing rapidly over the course of a few weeks. Extensive workup excluded an infammatory or infectious cause. Imaging studies revealed difuse thickening of the leptomeninges and serial CSF analysis showed raised opening pressures and increased protein levels. A diagnostic biopsy of the lower thoracic dura confrmed the diagnosis of primary difuse leptomeningeal gliomatosis (PDGL). She was managed supportively for her symptoms and unfortunately she passed away a few weeks later. 1. Introduction Primary difuse leptomeningeal gliomatosis is a rare cause of raised intracranial pressure and can afect any patients of any age. It is a challenging diagnosis requiring expert opinion and other diferentials must be ruled out before reaching the fnal diagnosis which usually can only be confrmed with a biopsy. 2. Case Report A 43-year-old lady presented to emergency department with a 3-week history of intermittent headaches, deteriorating vision, and dizziness with nausea and vomiting. A few days later she started having episodes of generalized tonic-clonic fts. Tere was no history of fever, weight loss, or recent travel abroad. Her past medical history was signifcant for an episode of lef sided weakness with facial weakness at age 19 which resolved on its own with no residual defcit. A CT scan at that time showed an area of damage in the right hemisphere within the white matter; these appearances were suggestive of an infarct. An MRI scan done at that time did not show any features consistent with multiple sclerosis. CSF analysis was within normal limits. Visual evoked potentials were also nor- mal. Te exact cause for this episode was not found and the patient was discharged with the advice to quit smoking. No further tests were done at that time. Since then, she remained ft and healthy with no further episodes of weakness. She was not on any regular medications. Her family history was unre- markable. Physical examination, including a full neurological examination, was also unremarkable. Tere was no focal neurology, neck stifness, or any other signs of meningism. Routine lab tests were all normal. With this presentation, head CT scan was an obvious frst choice investigation. It showed an area of low density within the right parietal region measuring about 2.7 cm, with no evidence of enhancement following injection of IV contrast and no mass efect (Fig- ure 1). A head MRI scan showed mature damage most likely due to an old infarct (Figure 2) but it also revealed leptome- ningeal enhancement along several regions of the brain (Figure 3). Based on the fndings of the head CT scan and head MRI scan the diferentials included difuse leptomeningeal disease (with an old infarct) as a result of infammation secondary to sarcoidosis, infection with tuberculosis (TB), and malignancy Hindawi Publishing Corporation Case Reports in Neurological Medicine Volume 2016, Article ID 5016840, 4 pages http://dx.doi.org/10.1155/2016/5016840