• Yipo Ma, Jinfeng Zhang, Ying Wen, Jinghua Chen, Lei Yuan, Xuechun Jiang, Dan Xu, and Kefu Liu.
• Department of Radiology, Taicang City Hospital of Traditional Chinese Medicine, Taicang, Jiangsu, China.
• Medicine (Baltimore). 2022 Sep 2; 101 (35): e30378e30378.

RationaleDiffuse low-grade gliomas (DLGGs) are relatively rare tumors that are more likely to be misdiagnosed and wrongly treated in clinical practice. We report a case of DLGG detected by computed tomography and magnetic resonance imaging (MRI).Patient ConcernsA 58-year-old man suddenly phantom smells for half an hour and was previously healthy.DiagnosesComputed tomography findings showed a leaf-shaped slightly hypodense shadow in the right temporal lobe with no obvious mass effect and an unclear boundary. MRI findings showed diffuse and slightly longer T1-weighted imaging (T1WI)/T2-weighted imaging (T2WI)signal in the right temporal lobe and hippocampus, slight hyperintensity on diffusion-weighted imaging, diffuse swelling in the right temporal lobe and hippocampus, and shallower cerebral sulci and fissures. No obvious abnormal enhancement was observed on enhanced MRI. Contrast-enhanced magnetic resonance angiography showed no obvious abnormality.InterventionsIntravenous thrombolysis with alteplase (rtPA) was given first.OutcomesThe patient had an acute and persistent generalized tonic-clonic seizure and was given antiepileptic treatment. Immunopathological and molecular genetic testing diagnosed as DLGGs. After targeted chemotherapy, the patient's symptoms improved significantly.LessonsFor those cases with clinical acute neurological impairment and imaging findings similar to those of ischemic stroke, where the distribution of lesions is inconsistent with the distribution of blood vessels, and the time of onset does not match the imaging findings, the possibility of DLGGs should be considered.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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