We can present our case with an unusual manifestation. Our case is a 15 year old girl, she presented in December 2011 with short-term diplopia. She had a complete evaluation in another hospital; she was found to have pathological visual evoked potentials on the left side. She had an MRI scan which showed multiple hyperintense, T2 hyperintense and CNS lesions and periventricular but in the suprasellar inner region there was no mass, no contrast enhancement was present in any of the lesions. Moreover she had a spinal tap with a CSF evaluation which detected intrathecal immunoglobulin, immunoglobulin synthesis, and oligoclonal bands. She was diagnosed with multiple sclerosis and referred to our hospital to the multiple sclerosis centre.

She had repeated MRI in February, the same result without any mass. She started methylprednisone treatment and was recommended for glatiramer acetate treatment in April. She unfortunately developed other symptoms at the beginning of August 2012; she developed amenorrhea and diabetes insipidus. She presented with polyuria, polydipsia which prompted another evaluation and this time, nine months after the first MRI, she was found to have this contrast enhancing lesion and another tumour in the pineal region.

Germinoma was suspected; she had a complete evaluation including the CSF. CSF HCG was elevated, not diagnostically. She had those elements, non-hematopoietic cells, and again on immunoelectro focusation [?] she had oligoclonal bands in the CSF, not in serum. So we suspected germinoma, she had a biopsy, there was super involvement in the as well, the diagnosis was clear and she was treated with craniospinal radiation. At the moment she is free of disease and on hormone replacement therapy and she is continuing with immunoglobulin treatment for the paraneoplastic syndrome.

Thank you for your attention.