A Suspected Multifocal High-Grade Glioma (Butterfly Pattern) Presenting with Progressive Hemiparesis, Focal Seizures, and Gait Disturbance in a Middle-Aged Farmer: A Case Study

Background: Butterfly gliomas are aggressive, diffusely infiltrating high-grade gliomas that cross the midline through the corpus callosum, producing a characteristic bihemispheric “butterfly” appearance on imaging. They typically present with rapidly progressive focal neurological deficits, behavioural change, and seizures, and carry a poor prognosis. Case Presentation: We report a middle-aged male farmer from rural Uttar Pradesh, India, who presented with a one-month history of progressive right-sided limb weakness, left-sided jerky limb movements, gait and handwriting difficulty, intermittent cervical pain, and chronic constipation. Magnetic resonance imaging of the brain demonstrated a large area of T1-hypointense, T2/FLAIR-hyperintense signal alteration with marked diffusion restriction involving the bilateral temporo-parietal region, the body and splenium of the corpus callosum, and the left occipital lobe — a pattern raising suspicion for a butterfly glioma, with acute ischaemic change considered less likely. He subsequently presented to the emergency department of a tertiary neurology centre with left-sided limb weakness, right hemiparesis, headache, and recurrent focal motor seizures of the left upper limb. Arterial blood gas analysis revealed hypoxaemia, mild hyponatraemia, hypocalcaemia, hyperglycaemia, and elevated lactate. He was started on corticosteroids, antiepileptic therapy, and a proton-pump inhibitor, with investigations advised to exclude infective and inflammatory mimics (viral markers, Toxoplasma serology, and TB-Gold/IGRA), and whole-body PET-CT to assess metabolic activity and extent of disease. On subsequent evaluation, PET-CT reportedly showed metabolically active lesions, and the patient was referred to neurosurgery for further management, including tissue diagnosis. Conclusion: This case highlights the diagnostic challenge posed by butterfly-pattern lesions of the corpus callosum, the multidisciplinary work-up required to distinguish glioma from its mimics, and the essential supportive and nursing-care needs of patients living with a probable high-grade glioma, including seizure precautions, steroid-side-effect monitoring, mobility support, and early palliative-care integration.