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Brainstem glioma

Case contributed by Amro Omar
Diagnosis almost certain


Nausea and vomiting, headache, bulbar signs, and ataxia.

Patient Data

Age: 6 years
Gender: Female

Multiplanar multisequence MRI shows the pons is swollen with a T1 hypointense / T2 hyperintense mass suggestive of intrinsic pontine glioma. Post-contrast T1 images show 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 increased Cho and decreased NAA.

Case Discussion

MRI demonstrates typical appearance of a brainstem glioma including: expansion of the pons by a high T2, low T2 signal mass, resulting in flattening of the floor of the fourth ventricle. Only patchy minor enhancement is present following administration of contrast. MRS demonstrates a typical tumor 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 which may be unilateral or bilateral.

For a full discussion of the condition, please refer to the article on brainstem gliomas

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