EP12.18 MULTIPLE HIGH GRADE GLIOMA IN YOUNG ADULT: A CASE REPORT FROM A DEVELOPING COUNTRY

Abstract BACKGROUND Multiple high-grade glioma is a rare case with poor prognosis. Based on communication between the lesions, it is differentiated into multifocal (MF) and multicentric (MC). The incidence of multiple HGG was 2-35% of central nervous system gliomas, prevalence rate was 19%. The prevalence rate of MC was 6%, while MF was 11%. CASE PRESENTATION 18-year-old boy, admitted to ER with status epilepticus. He had focal generalized seizures 5 months before, controlled with valproic acid. Bilateral ptosis, bilateral abducens palsy, left motoric lateralization were also found. He complained of gait imbalance, dysphagia, and left tinnitus 1 month before. Head CT showed obstructive hydrocephalus, so we consulted to neurosurgeon to do VP shunt. After VP shunt, GCS improved, but there were left total ophthalmoplegia, right oculomotor, trochlear, trigeminal, and central type facial nerve palsy. EEG showed background slowing activity, bilateral general slowing on both hemispheres especially left side, no sign of NCSE nor status epilepticus. Brain MRI showed multiple lesions in posterior pons, left cerebellum, bilateral thalamus, and left amygdala, suggestive multiple glioma. 8 days after VP shunt, we performed suboccipital decompressive craniectomy and tumor biopsy on left cerebellar vermis. The biopsy result was high-grade glioma. After surgery, he was treated in ICU for a week. 13 days after surgery, the seizures relapsed and there was hyponatremia. 15 days after surgery, there was acute respiratory failure so we intubated him again and then performed tracheostomy. Pneumonia appeared as a complication of long-term care. Due to the instability of patient’s condition, we postponed the chemoradiation. We also still could not do some molecular examination to distinguish whether this was an adult-type or pediatric-type glioma because of some limitation of health coverage. CONCLUSION Diagnosing and treating multiple high-grade glioma could be challenging, especially in young-adult. It should be distinguished between adult-type or pediatric-type. Multiple high-grade glioma commonly has poor prognosis. Although facing some limitations in diagnostic modalities, supportive treatment must be provided to stabilize the patient. Multidisciplinary approach between neurooncologist, neurosurgeon, neurointensivist, radiologist, pathologist is important to provide optimal treatment.