Crossing the line: Brainstem lesion in a patient with glioblastoma

Abstract

A 62-year-old man without significant past medical history presented a progressive right hemiparesis. Physical examination revealed spastic rigidity in the right upper and lower limb as well as increased deep tendon reflexes on the same side. Sensory testing was normal. Brain MRI was performed and the patient was diagnosed with diffuse glioblastoma. Six months later, a follow-up MR revealed T2-FLAIR (Fluid-attenuated Inversion-recovery) linear hyperintensity within the brainstemand bulbo-medullar junction with notable crossing of the midline (Fig. 1, Fig. 2).Fig. 2MRI FLAIR weighted axial images. (A) Hyperintensity of the corticospinal tract at the mid-brain level (arrow). (B) Hyperintensity of the corticospinal tract at the pons level (arrow).View Large Image Figure ViewerDownload Hi-res image Download (PPT) A.Wallerian degenerationB.Brainstem strokeC.Glial infiltrationD.Hemorrhage Answer on page 176. None. Clément Cholet – Reports no disclosures. Delphine Leclercq – Reports no disclosures. Bruno Law-ye – Reports no disclosures. The authors state that the subject has given their informed consent. This study was approved by our local Ethics Committee. Crossing the line: Brainstem lesion in a patient with glioblastomaJournal of Clinical NeuroscienceVol. 46PreviewThis case illustrates the precise radio-anatomic correlation made possible by modern high-resolution 3D imaging as it unequivocally evidences in vivo the corticospinal tract decussation. To our knowledge, no prior case with such precise anatomic detail was previously published. Our patient presented diffuse infiltrative glioblastoma, visualized as large areas of FLAIR (fluid-attenuated inversion-recovery) hyperintensities (Fig. 1A). Among the several lesions observed, one was located on the medial aspect of the primary motor cortex, before the central sulcus (Fig. Full-Text PDF