An Unusual Occurrence of Low-grade Astrocytic Tumor in Parieto-occipital Region

DESCRIPTION A male in his early 30s presented to the emergency department with complaints of dizziness and persistent headaches over the past week, prompting the seeking of medical attention due to symptom progression. The patient had no prior medical history, familial medical conditions, or other comorbidities, and displayed normal blood pressure and other vital signs. Magnetic resonance imaging (MRI) investigation was requested and carried out. A distinctive round-to-oval, ring-enhancing lesion with altered signal intensity was observed, appearing hyperintense on T2, hypointense on T1, and fluid-attenuated inversion recovery sequences. The lesion displayed no diffusion restriction on diffusion-weighted imaging and no susceptibility artifacts on gradient echo (GRE). The lesion measured approximately 4.2 cm × 3.7 cm × 2.8 cm and showed extension toward the left tentorium cerebelli. This radiological presentation aligned with the typical appearance of low-grade insular gliomas, which tend to present as expansive, infiltrative masses [Figures 1 and 2]. On the other hand, the magnetic resonance spectroscopy of the region detected an elevation in both the creatinine-choline peak and lipid lactate levels aligning with the well-established metabolic changes, increased cellular activity, and the presence of oxygen-deprived regions commonly associated with such tumors [Figure 3].Figure 1: Sagittal T1-weighted image demonstrating a predominantly hypointense parieto-occipital lobe lesionFigure 2: Axial T2-weighted image demonstrating a predominantly hyperintense parieto-occipital lobe lesionFigure 3: Magnetic resonance spectroscopy image showing an increased creatinine-choline peak and increased lipid lactate at the site of lesionLow-grade gliomas are benign brain tumors, originating from astrocytes and oligodendrocytes, classified as WHO Grade 1 and 2.[1] In our case, the glioma was located in the atypical parieto-occipital lobe, deviating from the more common frontal and temporal lobe sites.[2] Patients with low-grade gliomas are subjected to slow growth and will eventually turn fatal. Hence, follow-up is crucial in such cases despite better survival rates than those with high-grade gliomas (WHO grade 3 or 4).[3] LEARNING POINTS/TAKE HOME MESSAGES Low-grade astrocytoma diagnosis relies on imaging studies, notably computed tomography scans or MRI of the brain, enabling the assessment of anatomical position and size of the tumor Treatment includes surgical resection and further histological studies should be performed. Surgery with maximal safe resection is the treatment of choice for both primary and recurrent tumors. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.