Difficulty in walking
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There is a large heterogeneous pontine mass causing expansion of the pons. It returns predominantly low signal intensity on T1WI, high signal intensity on T2WI/FLAIR with subtle post-contrast enhancement. No diffusion restriction is noted on DWI/ADC map sequences. No convincing drop out signal is noted on T2* GRE sequence to suggest calcification.
The mass is effacing the fourth ventricle causing minimal dilatation of the lateral and third ventricles. Partial encasement of the basilar artery is noted.
A note is made of a small lesion within the left putamen nucleus returning CSF signal intensity on all MR sequences without diffusion restriction or surrounding gliosis representing enlarged Virchow-Robin space.
Diffuse brainstem glioma makes 15–20% of all CNS neoplasms in children. They are the main cause of mortality in children due to brain tumors.
Dr. Farhad Farzam has also contributed to this case.