Presentation
Headache.
Patient Data
Severe hydrocephalus with dilatation of the lateral and third ventricles. Normal fourth ventricle size. Appearances of a tectal plate mass.
Tectal plate is enlarged and T2 hyperintense resulting in narrowing of the cerebral aqueduct. Hydrocephalus is present. CSF flow voids through the floor of the third ventricle in keeping with ventriculostomy. No post contrast enhancement.
Case Discussion
The enlargement and T2 hyperintensity of the tectal plate is almost certainly a low-grade glioma, with confidence in the diagnosis more certain as it has been followed for 5 years with no change. Histological confirmation is almost never available due to difficulty in access for biopsy let alone the potential complications of biopsying the brainstem.