MyPACS.net: Radiology Teaching Files > Case 52507181

Never visited BRAINSTEM LESION
Contributed by: C Michaels, Radiologist, Yale-New Haven Hospital, Connecticut, USA.
Patient: 61 year old female
History: known h/o of brain stem lesion
Images:[small]larger

Fig. 1: Sag T1 SE demonstrates midline anatomy; brain stem appears uniformly isointense

Fig. 2: Axial T2 FSE indicates region of hyperintensity in the anterior region of the cerebellum

Fig. 3: Sag T1 post contrast shows The study demonstrates a mass abutting the junction of the inferior pons and superior medulla in the posterior aspect of the brainstem.

Fig. 4: Coronal t1 post contrast shows The study demonstrates a mass abutting the junction of the inferior pons and superior medulla in the posterior aspect of the brainstem.

Fig. 5: Coronal Flair shows homogeneous enhancement of lesion in the region of the pons and rostral medulla
Findings:

The study demonstrates a mass abutting the junction of the inferior pons and superior medulla in the posterior aspect of the brainstem. The lesion measures 14 mm AP x 14 mm TR x 21 mm cephalocaudad. There is homogeneous enhancement on the post-contrast T1 weighted sequences.

The cortical sulci and ventricles are within normal limits. No intra or extra-axial fluid collections are noted.

The visualized orbits, osseous structures, mastoid air cells and paranasal sinuses are unremarkable.

No evidence of restricted diffusion; Perfusion images are somewhat limited secondary to magnetic
susceptibility artifacts, but there is increased perfusion in the vicinity of the brainstem abnormality suggesting more activity (DWI and perfusion images are not shown).

Discussion:

Brainstem glioma can include:
Tectal glioma (tectal), Focal tegmental mesencephalic, Pilocytic astrocytoma, Fibrillary astrocytoma

Clinically, Brainstem gliomas usually present during childhood with cranial nerve palsies and subsequent long tract signs in the extremities. There are three distinct anatomic locations where brainstem gliomas tend to occur: pontine, tectal, and cervicomedullary. Eventually signs of intracranial pressure appear and a shunt may be needed to avoid cerebral herniation. Brainstem gliomas make up almost 10% of intracranial tumors in children. Morbidity occurs due to the compression of surrounding structures by the tumor itself, edema, or hemorrhage.

Presentation: Average age is 7 years, occurs in equal proportions of male and female population. Three-fourths of patients being younger than 20 years old.  Most common signs/symptoms:
a) Tectal: Macrocrania; headaches
b) Focal tegmental mesencephalic: Hemiparesis
c) Diffuse intrinsic pontine gloma: Ataxia, headache, bulbar signs, nausea and vomiting, multiple cranial nerve palsies.

Ddx for brainstem gliomas include:

- Congenital aqueductal stenosis vs tectal glioma
- Tectal glioma vs Alexander disease
- DPG vs Neurofibromatosis Type I
- Other brainstem gliomas
- DPG vs Histiocytosis
- Granuloma (TB) vs DPG
- Brainstem encephalitis vs DPG

Comments:
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Additional Details:

Case Number: 52507181Last Updated: 2011-06-06
Anatomy: Other   Pathology: Other
Modality: MRAccess Level: Readable by all users
Keywords: vascular, neoplasm

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