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