Presentation
Headache and vomiting.
Patient Data
An endo-exophytic space occupying lesion is projecting from the dorsal aspect of the right midbrain, bulging into the quadrigeminal cistern. The mass is heterogeneous showing small anterior cystic areas and solid enhancing areas. It's compressing the aqueduct of sylvius with subsequent moderate supratentorial hydrocephalus and CSF permeation.
Pathology after biopsy showed midbrain ganglioglioma WHO grade I.
Case Discussion
Infratentorial gangliogliomas such as brain stem, CPA, spinal cord lesions are rare.
Clinical presentations are usually focal neurological deficits, cranial nerve palsy, hydrocephalus, increased intracranial pressure, myoclonus, and speech or gait changes.
Radiographically, the imaging characteristics of ganglioglioma are highly variable and it is usually difficult to distinguish the other brainstem tumor such as subependymomas, ependymomas, or brain stem gliomas. It usually shows an iso- to hypointense signal on T1-weighted MR images and hypersignal on T2-weighted images, with variable enhancement ranging from no-enhancement to marked, heterogeneous enhancement.