Brainstem glioma

Case contributed by Ahmed Abdrabou
Diagnosis certain


progressive headache. Previous CT revealed hydrocephalus and VP shunt tube was placed.

Patient Data

Age: 6 years old
Gender: Male

A well defined oval shape lesion is seen occupying the posterior aspect of the pons, indenting the ventral wall of the 4th ventricle and results in supra tentorial hydrocephalic changes. The lesion displays low T1, bright T2, low FLAIR signal intensity, cystic center with irregular peripheral solid enhancement on post contrast study. MRS of the solid component of the lesion displays high Cho, reduced NAA peak with inverted lactate duplet. Previous VP shunt track is noted.

Case Discussion

Pediatric brainstem glioma is one of the commonest pediatric tumor and can be focal or diffuse. Presence of enhancement and MRS features favor high grade lesion. Biopsy from this lesion revealed WHO grade III fibrillary pattern.

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