Cerebellar oligodendroglioma mimicking spinal degeneration in an elderly male: A case report and literature review

INTRODUCTION

At present, central nervous system and brain tumors rank 19^th in incidence and 12^th in mortality worldwide, with more than half of the cases occurring in Asia, highlighting the significant impact of this disease in Asian countries.^[1-3] Common clinical manifestations of brain tumors include headaches, seizures, limb weakness, increased intracranial pressure, and aphasia. The clinical presentation of brain tumors can vary significantly, depending on the location and characteristics of the tumor. Oligodendroglioma, a slow-growing tumor, most frequently manifests as focal or generalized seizures. However, some cases are diagnosed incidentally through brain imaging performed for other reasons, such as migraines or trauma.^[4,5] They typically affect younger adults, are most often located in the frontal lobes, and commonly present with seizures and localized neurological deficits. In contrast, posterior fossa oligodendrogliomas are extremely uncommon and often present diagnostic challenges due to their nonspecific symptoms, particularly in older patients.^[5-8] The overlap of such symptoms with those of more prevalent conditions, such as spinal degenerative diseases or post-traumatic syndromes, can result in delayed or incorrect diagnoses. We present a rare case of cerebellar oligodendroglioma in an elderly male who was initially misdiagnosed as having a spinal pathology.

CASE REPORT

A 77-year-old male with type 2 diabetes, hypertension, coronary artery disease, chronic kidney disease, and bilateral total knee replacements presented after a traffic accident. He reported mild headache and dizziness without loss of consciousness. The patient denied anticoagulant, antiplatelet, or sedative use. Based on the Canadian computed tomography (CT) head rule, brain CT revealed no acute findings [Figure 1]. Gait instability and urinary incontinence developed over subsequent weeks. Spinal magnetic resonance imaging (MRI) revealed moderate canal stenosis, which was initially attributed to a degenerative disease.

Close

Figure 1:

Non-contrast axial computed tomography showing no acute intracranial hemorrhage or fracture (L: left side).

Export to PPT

At 6–8 months post-injury, the symptoms persisted and worsened. Physical examination revealed that the patient was alert and oriented, with complete extraocular movements, no nystagmus, intact visual fields, no facial weakness, normal tongue movement, negative straight leg raise and Patrick tests, and decreased deep tendon reflexes in both legs. A new masked facial expression and inability to walk for more than a few minutes prompted a brain MRI, revealing a left cerebellar mass [Figure 2]. Suboccipital craniotomy achieved gross total resection with pathological confirmation of World Health Organization grade III oligodendroglioma. Postoperative radiotherapy was administered. By 3 months, gait, dizziness, and urinary control had markedly improved, with sustained recovery at 12 months.

Close

Figure 2:

Axial T2-weighted magnetic resonance imaging showing a hyperintense tumor in the left cerebellar hemisphere (yellow arrows) (L: left side).

Export to PPT

DISCUSSION

The exact etiology of primary brain tumors is unclear, although 1–5% of cases may be related to genetic predisposition, as well as other factors such as radiation, diet, allergies, trauma, and infection.^[9] These tumors often arise in the frontal lobes, typically show slow growth, and are more common in younger patients.^[5,10]

After mild head trauma, concussion symptoms usually resolve within days to weeks, and often within 72 h in mild cases. Persistence beyond the expected period, particularly in older adults, should prompt the consideration of other diagnoses, such as intracranial tumors. In this case, the symptoms persisted for over 1 month post-injury, with new neurological signs and bilateral lower limb hyporeflexia, leading to a suspicion of post-traumatic syndrome. This prompted a brain MRI, which identified a cerebellar mass.

The gold standard for diagnosis involves neuroimaging, with MRI and CT initially used to assess tumor morphology and location. Oligodendrogliomas typically appear as non-enhancing lesions with mild peritumoral edema or mass effect.^[7] Once detected, histopathological confirmation through biopsy or resection, supplemented by molecular analysis, determines the tumor type, grade, and prognosis.^[7,8] Treatment options include surgery, radiation, and chemotherapy, selected according to the tumor grade, location, and patient condition. Surgical resection is the preferred first-line intervention for maximal tumor removal with neurological preservation. Complete resection can improve survival and is curative in some cases. Adjuvant radiotherapy is recommended for incompletely resected or high-grade tumors. Evidence suggests that early radiation offers better survival and seizure control than delayed treatment.^[8,11,12]

CONCLUSION

Oligodendrogliomas are rare brain tumors usually found in the frontal lobes of younger patients. This case of an elderly patient with a cerebellar tumor highlights the necessity of recognizing warning signs that are atypical for the usual course of mild head injury recovery, including persistent dizziness, gait instability, and emerging neurological signs. These features prompted further neuroimaging, leading to a timely diagnosis. Clinicians should maintain a broad differential diagnosis and pursue early imaging when symptoms persist beyond expected concussion recovery to avoid delayed diagnosis and optimize outcomes.