A clinically isolated syndrome:butterfly glioma mimic

The report explores a unique and treatable“butterfly”-glioma mimic and the neuroimaging characteristics that help to diagnose this entity.A 35-year-old patient presented with subacute-onset,progressive frontal lobe dysfunction followed by features of raised intracranial pressure.Neuroimaging features were consistent with a“butterfly”lesion that favored the possibility of a gliomatosis cerebri with significant edema and marked corpus callosum and fornix thickening.Contrast-enhanced and perfusion images revealed a confluent tumefactive lesion with a characteristic“broken-ring”pattern of enhancement,mass-effect and low perfusion;features favoring an alternative inflammatory pathology.This was peculiar as calloso-forniceal involvement of this nature has not been previously reported in inflammatory demyelinating mass lesions.This was confirmed as a tumefactive demyelination on histopathology.Following treatment,on clinical and imaging follow-up,significant resolution was evident suggesting a monophasic illness.This case highlights the stringent clinico-radiological-pathological approach required in the evaluation and management of butterfly lesions despite the striking imaging appearances.Tumefactive demyelination in this patient represents a clinically isolated syndromic presentation of an inflammatory pathology that can resemble gliomatosis cerebri.These“butterfly”-glioma mimics are scarcely reported in the literature,are eminently treatable with variable prognosis and prone for relapse.