44 year old man presents with one week history of paresthesia, ataxia and slurred speech.
Cranial nerves intact.
Normal laboratory evaluation
â€¢ Multifocal enhancing masses in midbrain, pons and medulla.
â€¢ Homogeneous enhancement following contrast.
â€¢ No hydrocephalus.
â€¢ Metastatic disease
â€¢ Multiple Sclerosis
â€¢ Multi-centric glioma
Brainstem gliomas are quite unusual in adults.
Most such lesions are not anaplastic and typically present in children. The new WHO classification (2007) indicates that any vascular changes upgrade the neoplasm from anaplastic to GBM. Thus, contrast enhancement should be viewed as a very ominous finding.
Definition: A diffusely infiltrating astrocytoma with focal or dispersed anaplasia, and a marked proliferative potential. Anaplastic astrocytomas arise from low-grade astrocytomas, but are also diagnosed at first biopsy, without indication of a less malignant precursor lesion. They have an intrinsic tendency for malignant progression to glioblastoma.
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