Brainstem glioma

Case contributed by Dr Hanisalam

Presentation

Bulbar palsies and headache.

Patient Data

Age: 10 years
Gender: Female

CT brain

Modality: CT

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 brain

Modality: MRI

MRI of the brain confirms the presence of large mass expanding the pons. It is hypointense on T1 weighted imaging and hyperintense on T2 weighted images, 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 haemorrhage 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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Case Information

rID: 9444
Case created: 19th Apr 2010
Last edited: 4th Dec 2015
Inclusion in quiz mode: Included

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