Abstract
Lhermitte–Duclos disease (LDD) is a rare cerebellar disorder characterized by diffuse or focal enlargement of cerebellar folia. Clinical manifestations are usually related to a mass effect and secondary obstructive hydrocephalus. Increased intracranial pressure symptoms and cerebellar symptoms are the most frequent patient complaints. We describe the case of a patient with LDD who developed secondary obstructive hydrocephalus. A 68-year-old woman was brought to the emergency room for sudden vertigo following several bouts of vomiting and headache. There were no external signs of trauma, serious illness or infection. On admission, the patient was alert and had no neurological deficits. Brain computed tomography (CT) and magnetic resonance imaging (MRI) showed hydrocephalus and a cerebellar mass in the right cerebellar hemisphere compressing the fourth ventricle. Suboccipital craniotomy and subtotal removal of the mass was performed. Pathological study of the surgical specimen showed abnormal ganglionic neurons and an enlarged molecular layer compatible with dysplastic gangliocytoma. Cytoreduction can achieve improvement in symptoms caused by mass effect, but postoperative swelling may aggravate obstructive hydrocephalus. Therefore, if symptoms still remain after removal of the mass, an additional shunting procedure may be needed as a further management option.
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References
Ashley D, Zee C, Chandrasoma P, Segall H (1990) Lhermitte-Duclos disease: CT and MR findings. J Comput Assist Tomogr 14:984
Carter J, Merren M, Swann K (1989) Preoperative diagnosis of Lhermitte-Duclos disease by magnetic resonance imaging. J Neurosurg 70:135–137
Derrey S, Proust F, Debono B, Langlois O, Layet A, Layet V, Longy M, Freger P, Laquerriere A (2004) Association between Cowden syndrome and Lhermitte-Duclos disease: report of two cases and review of the literature. Surg Neurol 61:447–454
Hair L, Symmans F, Powers J, Carmel P (1992) Immunohistochemistry and proliferative activity in Lhermitte-Duclos disease. Acta Neuropathol 84:570–573
Hashimoto H, Iida J, Masui K, Nishi N, Sakaki T (1997) Recurrent Lhermitte-Duclos disease–case report. Neurol Med Chir (Tokyo) 37:692–696
Hobert JA, Eng C (2009) PTEN hamartoma tumor syndrome: an overview. Genet Med 11:687–694
Lynch NE, Lynch SA, McMenamin J, Webb D (2009) Bannayan-Riley-Ruvalcaba syndrome: a cause of extreme macrocephaly and neurodevelopmental delay. Arch Dis Child 94:553–554
Marano SR, Johnson PC, Spetzler RF (1988) Recurrent Lhermitte-Duclos disease in a child. Case report. J Neurosurg 69:599–603
Meltzer C, Smirniotopoulos J, Jones R (1995) The striated cerebellum: an MR imaging sign in Lhermitte-Duclos disease (dysplastic gangliocytoma). Radiology 194:699
Nowak DA, Trost HA (2002) Lhermitte-Duclos disease (dysplastic cerebellar gangliocytoma): a malformation, hamartoma or neoplasm? Acta Neurol Scand 105:137–145
Nowak D, Trost H, Porr A, Stolzle A, Lumenta C (2001) Lhermitte-Duclos disease (Dysplastic gangliocytoma of the cerebellum). Clin Neurol Neurosurg 103:105–110
Oppenheimer DR (1955) A benign tumour of the cerebellum; report on two cases of diffuse hypertrophy of the cerebellar cortex with a review of nine previously reported cases. J Neurol Neurosurg Psychiatry 18:199–213
Padberg G, Schot J, Vielvoye G, Bots G, De Beer F (2004) Lhermitte-Duclos disease and Cowden disease: a single phakomatosis. Ann Neurol 29:517–523
Prez-Nez A, Lagares A, Bentez J, Urioste M, Lobato RD, Ricoy JR, Ramos A, Gonzlez P (2004) Lhermitte-Duclos disease and Cowden disease: clinical and genetic study in five patients with Lhermitte-Duclos disease and literature review. Acta Neurochir (Wien) 146:679–690
Rainov N, Holzhausen H, Burkert W (1995) Dysplastic gangliocytoma of the cerebellum (Lhermitte-Duclos disease). Clin Neurol Neurosurg 97:175–180
Roski RA, Roessmann U, Spetzler RF, Kaufman B, Nulsen FE (1981) Clinical and pathological study of dysplastic gangliocytoma. Case report. J Neurosurg 55:318–321
Vinchon M, Blond S, Lejeune J, Krivosik I, Fossati P, Assaker R, Christiaens J (1994) Association of Lhermitte-Duclos and Cowden disease: report of a new case and review of the literature. Br Med J 57:699
Williams DW, Elster AD, Ginsberg LE, Stanton C (1992) Recurrent Lhermitte-Duclos disease: report of two cases and association with Cowden’s disease. AJNR Am J Neuroradiol 13:287–290
Yachnis A, Rorke L, Trojanowski J (1994) Cerebellar dysplasias in humans: development and possible relationship to glial and primitive neuroectodermal tumors of the cerebellar vermis. J Neuropathol Exp Neurol 53:61
Yachnis A, Trojanowski J, Memmo M, Schlaepfer W (1988) Expression of neurofilament proteins in the hypertrophic granule cells of Lhermitte-Duclos disease: an explanation for the mass effect and the myelination of parallel fibers in the disease state. J Neuropathol Exp Neurol 47:206
Zhou X, Marsh D, Morrison C, Chaudhury A, Maxwell M, Reifenberger G, Eng C (2003) Germline inactivation of PTEN and dysregulation of the phosphoinositol-3-kinase/Akt pathway cause human Lhermitte-Duclos disease in adults. Am J Hum Genet 73:1191–1198
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This study was supported by the research fund of Hanyang University (HY-2006-C).
Conflict of interest statement We declare that we have no conflict of interest.
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Yang, M.S., Kim, C.H., Cheong, J.H., Kim, J.M. (2012). Lhermitte–Duclos Disease Presenting with Hydrocephalus. In: Aygok, G., Rekate, H. (eds) Hydrocephalus. Acta Neurochirurgica Supplementum, vol 113. Springer, Vienna. https://doi.org/10.1007/978-3-7091-0923-6_32
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