Brain stem glioma
6 year old female presented with nausea and vomiting, headache, bulbar signs and ataxia.
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Multiplanar multisequence MRI shows the pons is swollen with intrinsic pontine glioma (fibrillary astrocytoma). T1 C+ MR shows pontine expansion by predominantly low T1WI signal mass. Minimal focal enhancement is present. Note absence of hydrocephalus despite size of mass.
DWI and spectroscopy confirms the malignant nature of the disease.
MR spectroscopy demonstrates typical malignant trace, with increased Cho and decreased NAA.
MRI demonstrates typical appearance of a brainstem glioma. The pons is expanded by a high T2, low T2 signal mass, resulting in flattening of the floor of the fourth ventricle. Following administration of contrast patchy minor enhancement is present.
MRS demonstrates a typical tumour trace with elevated choline and depressed NAA.
Brain stem gliomas account for 10–20% of pediatric central nervous system tumors, and 75% of these occur before the age of 20 years.
The most common neurologic signs at diagnosis, in 75% of patients, are seventh nerve palsy, horizontal nystagmus, as well as cerebellar and pyramidal signs, unilateral or bilateral .
For a full discussion of the condition, please refer to the article on brainstem gliomas.