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Images in Neurology |

Diffuse Brain Stem Glioma

Dimitri Renard, MD; Anne Le Floch, MD; Laurent Collombier, MD; Marie De Verdal, MD; Chantal Campello, MD; Pierre Labauge, MD, PhD
Arch Neurol. 2010;67(3):368-369. doi:10.1001/archneurol.2010.12.
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A 55-year-old woman had progressive gait unsteadiness, vertigo, and intermittent diplopia for 1.5 years. Clinical examination revealed multidirectional gaze-evoked nystagmus, bilateral Babinski sign, and gait and (left-predominant) limb ataxia. Brain magnetic resonance imaging (Figure 1) showed a diffuse brain stem and cerebellar infiltrative process without gadolinium enhancement on T1-weighted imaging. In contrast to early fludeoxyglucose F 18 positron emission tomographic images, late images revealed brainstem hypermetabolism, most prominent in the mesencephalon (Figure 2). Stereotactic biopsy of the left middle cerebellar peduncle revealed a glioma (World Health Organization grade 2). A diagnosis of diffuse low-grade brain stem glioma was made and temozolomide chemotherapy was started.

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Figure 1.

Magnetic resonance images showed expansion (arrow) of the entire brain stem on a sagittal T1-weighted image (A) and diffuse brain stem and cerebellar white matter infiltration (arrows) with left-sided predominance in the cerebellum and mesencephalon on fluid-attenuated inversion recovery images (B-F). B and C are coronal views; D-F are axial views.

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Figure 2.

Early (A) and late (B) fludeoxyglucose F 18 positron emission tomographic images. A, The early images showed normal metabolism. Arrow indicates normal brain stem hypermetabolism. B, The late images (ie, 6 hours after radiotracer injection) clearly revealed brain stem hypermetabolism, especially in the mesencephalon (arrow).

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