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Low-Grade Glioma – Malignant Transformation — SCE Neurology MCQ

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HardNeuro-oncologyLow-Grade Glioma – Malignant TransformationSCE Neurology

A 52-year-old man with a known left frontal low-grade glioma (WHO grade 2 astrocytoma, IDH-mutant) diagnosed 2 years ago now presents with increasing seizure frequency and new right arm weakness. MRI shows enlargement of the tumour with new contrast enhancement. What does the new enhancement most likely indicate?

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Correct answer: E — Malignant transformation to higher grade

The best answer is “Malignant transformation to higher grade”. NICE bases epilepsy diagnosis and treatment on seizure type, syndrome, recurrence risk, comorbidity, pregnancy potential and medicine harms; typical provoked seizures are managed by correcting the provoking cause. The alternatives “Radiation necrosis, within the relevant UK pathway”, “Pseudoprogression, after excluding important mimics”, “Tumour haemorrhage, after specialist assessment”, “Abscess formation, when the phenotype supports it” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: NICE NG217 epilepsy recommendations: https://www.nice.org.uk/guidance/ng217/chapter/Recommendations