Large Brainstem



Large Brainstem


Karen L. Salzman, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Brainstem Glioma


  • Hypertensive Intracranial Hemorrhage


Less Common



  • Intracranial Hypotension


  • Osmotic Demyelination Syndrome


  • Cerebral Ischemia-Infarction, Acute


  • Demyelination


  • Encephalitis


  • Cavernous Malformation


Rare but Important



  • Metastases, Parenchymal


  • Syringobulbia


  • Hypertrophic Olivary Degeneration


  • Hemangioblastoma


ESSENTIAL INFORMATION


Helpful Clues for Common Diagnoses



  • Brainstem Glioma



    • Pontine > medulla > mesencephalic glioma


    • Enlarged, T2 hyperintense mass


  • Hypertensive Intracranial Hemorrhage



    • Pons hemorrhage in a hypertensive patient


    • Basal ganglia > thalamus > pons


Helpful Clues for Less Common Diagnoses



  • Intracranial Hypotension



    • Downward displacement of brain through incisura (“slumping” midbrain)



      • “Fat pons” can mimic neoplasm!


    • ± Dural enhancement, SDH


  • Osmotic Demyelination Syndrome



    • Typically involves central pons


    • T2 hyperintense, ± enhancement, DWI


  • Cerebral Ischemia-Infarction, Acute



    • “Top of the basilar”: Midbrain & thalamic infarcts ± temporal & occipital lobes


    • May have midbrain, pons, or medulla ischemia related to vertebrobasilar perforator or cerebellar artery disease


    • T2 hyperintense edema, DWI bright


  • Demyelination



    • Includes multiple sclerosis & ADEM


    • Brainstem enlargement with acute lesions


    • Focal T2 hyperintensity ± enhancement


  • Encephalitis



    • T2 hyperintensity & enhancement typical


    • Etiologies include Listeria monocytogenes, enterovirus, West Nile virus, herpes, EBV, adenovirus, Japanese encephalitis


  • Cavernous Malformation



    • Heterogeneously bright on T1 & T2


    • Hemosiderin rim classic

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Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Large Brainstem

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