Bilateral astrocytomas: Clinicoradiological characteristics and endoscopic management

Bithalamic astrocytoma is an extremely rare condtion associated with progressive neurobehavioural syndrome and dementia. We report a 17-year-old boy who presented with headache and memory loss. His magnetic resonance imaging revealed large bithalamic, symmetrical, non-enhancing lesions with moderate hydrocephalus and tonsillar herniation. Magnetic responance spectroscopy revealed high choline and creatinine peaks. An endoscopic guided biopsy and ventriculoperitoneal shunt placement was followed by radiotherapy. The biopsy revealed grade II fibrillary astrocytoma. He was initially relieved of raised pressure symptoms but developed tremors and progressive neruobehavioural dysfunction and died after 3 years