Ju-Hwi Kim1, Tae-Young Jung2,3, Seung-Hoon Jung1, Kyung-Hwa Lee4, Seul-Kee Kim5. 1. Department of Neurosurgery, Chonnam National University Medical School, Gwangju, Republic of Korea. 2. Department of Neurosurgery, Chonnam National University Medical School, Gwangju, Republic of Korea. jung-ty@chonnam.ac.kr. 3. Department of Neurosurgery, Chonnam National University Hwasun Hospital, 160, Ilsim-ri, Hwasun-eup, Hwasun-gun, Jeollanam-do, 519-809, Republic of Korea. jung-ty@chonnam.ac.kr. 4. Department of Pathology, Chonnam National University Hwasun Hospital, Gwangju, Republic of Korea. 5. Department of Radiology, Chonnam National University Hospital, Gwangju, Republic of Korea.
Abstract
PURPOSE: We report a rare case of brainstem abscess with hemorrhage mimicking diffuse intrinsic pontine glioma (DIPG). METHODS: A 7-month-old baby girl presented with lethargy and poor oral feeding. She had the mild fever for 1 month. Brain computed tomography revealed the hypodense lesion in the pons. Brain magnetic resonance images (MRI) showed around 1.4-cm-sized rim-enhanced mass with perilesional edema and internal hemorrhage in the pons. The cerebral blood volume was increased in the rim-enhanced area. The provisional diagnosis was DIPG, but the mass did not show the expansile mass with encasement of the basilar artery on the ventral pons. RESULTS: The biopsy was done via the floor of the fourth ventricle, and the pathologic findings showed the many inflammatory cells and CD68-immunopositive macrophage which were compatible with abscess. The antibiotics with ceftriaxone and metronidazole were administrated for 11 weeks, and the follow-up MRI showed the slightly small enhanced lesion without central necrotic area. Three years later, follow-up MRI revealed the encephalomalacic change and atrophy of the pons. She had the stable neurologic deficit of left facial palsy and right hemiparesis. CONCLUSION: The biopsy could be necessary for pontine lesions without typical radiologic findings of DIPG.
PURPOSE: We report a rare case of brainstem abscess with hemorrhage mimicking diffuse intrinsic pontine glioma (DIPG). METHODS: A 7-month-old baby girl presented with lethargy and poor oral feeding. She had the mild fever for 1 month. Brain computed tomography revealed the hypodense lesion in the pons. Brain magnetic resonance images (MRI) showed around 1.4-cm-sized rim-enhanced mass with perilesional edema and internal hemorrhage in the pons. The cerebral blood volume was increased in the rim-enhanced area. The provisional diagnosis was DIPG, but the mass did not show the expansile mass with encasement of the basilar artery on the ventral pons. RESULTS: The biopsy was done via the floor of the fourth ventricle, and the pathologic findings showed the many inflammatory cells and CD68-immunopositive macrophage which were compatible with abscess. The antibiotics with ceftriaxone and metronidazole were administrated for 11 weeks, and the follow-up MRI showed the slightly small enhanced lesion without central necrotic area. Three years later, follow-up MRI revealed the encephalomalacic change and atrophy of the pons. She had the stable neurologic deficit of left facial palsy and right hemiparesis. CONCLUSION: The biopsy could be necessary for pontine lesions without typical radiologic findings of DIPG.