Lakhan Shaheen E, Harle Lindsey
Global Neuroscience Initiative Foundation, Los Angeles, CA, USA.
J Med Case Rep. 2009 Oct 30;3:87. doi: 10.1186/1752-1947-3-87.
Brainstem gliomas are rare in adults. They most commonly occur in the pons and are most likely to be high-grade lesions. The diagnosis of a high-grade brainstem glioma is usually reached due to the presentation of rapidly progressing brainstem, cranial nerve and cerebellar symptoms. These symptoms do, however, overlap with a variety of other central nervous system disorders. Magnetic resonance imaging is the radiographic modality of choice, but can still be misleading.
A 48-year-old Caucasian woman presented with headache and vomiting followed by cerebellar signs and confusion. Magnetic resonance imaging findings were suggestive of a demyelinating process, but the patient failed to respond to therapy. Her condition rapidly progressed and she died. At autopsy, a high-grade invasive pontine tumor was identified. Histological evaluation revealed glioblastoma multiforme.
While pontine gliomas are rare in adults, those that do occur tend to be high-grade and rapidly progressive. Progression of symptoms from non-specific findings of headache and vomiting to rapid neurological deterioration, as occurred in our patient, is common in glioblastoma multiforme. While radiographic findings are often suggestive of the underlying pathology, this case represents the possibility of glioblastoma multiforme presenting as a deceptively benign appearing lesion.
脑干胶质瘤在成人中较为罕见。它们最常发生于脑桥，且最有可能是高级别病变。高级别脑干胶质瘤的诊断通常是基于快速进展的脑干、颅神经及小脑症状。然而，这些症状与多种其他中枢神经系统疾病的症状有重叠。磁共振成像（MRI）是首选的影像学检查方式，但仍可能产生误导。
一名48岁的白种女性，最初表现为头痛和呕吐，随后出现小脑体征及意识模糊。MRI检查结果提示为脱髓鞘病变，但患者对治疗无反应。其病情迅速进展，最终死亡。尸检发现一个高级别浸润性脑桥肿瘤。组织学评估显示为多形性胶质母细胞瘤。
虽然脑桥胶质瘤在成人中罕见，但一旦发生往往是高级别且进展迅速。正如我们的患者那样，症状从非特异性的头痛和呕吐发展到快速的神经功能恶化，在多形性胶质母细胞瘤中很常见。虽然影像学表现常常提示潜在的病理情况，但该病例表明多形性胶质母细胞瘤有可能表现为看似良性的病变。
