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Images in Neurology
March 2010

Diffuse Brain Stem Glioma

Author Affiliations

Author Affiliations: Departments of Neurology (Drs Renard, Le Floch, De Verdal, Campello, and Labauge) and Nuclear Medicine (Dr Collombier), Centre Hospitalier Universitaire de Nîmes, Hôpital Caremeau, Nîmes, France.

Arch Neurol. 2010;67(3):368-369. doi:10.1001/archneurol.2010.12

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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