Presentation
Bulbar palsies and headache.
Patient Data
Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.
Non-contrast CT of the brain demonstrates a large heterogenous mass expanding the pons, distorting the fourth ventricle and resulting in a degree of hydrocephalus. The mass is predominantly hypoattenuating centrally, with a region of relative hyperattenuation peripherally on the left.
MRI of the brain confirms the presence of a large mass expanding the pons. It is T1W hypointense and T2W hyperintense, with areas on the left which demonstrate fluid signal intensity and mostly attenuated on FLAIR. These areas also demonstrate peripheral irregular contrast enhancement. The mass overall does not demonstrate restricted diffusion, nor are there convincing areas of calcification or hemorrhage on gradient echo.
The fourth ventricle is effaced and hydrocephalus is present.
Case Discussion
This case is typical of a high grade diffuse brainstem glioma. In many centers when features are typical, no biopsy is carried out, as biopsies of the brainstem have high morbidity, and histological confirmation often has little impact on treatment.
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