Extended Cranial Ultrasound Views in Infants with Acute Brain Stem/Infratentorial Lesions: Diagnosis of a Progressive Midline Glioma in a 6-Week-Old Infant

Florian Beske,Matthias Lange,Bernd Mitzlaff,Holger Koester,Johannes Woitzik,Wiebke Aumann,Axel Heep,Hermann L Mueller

doi:10.1055/s-0041-1736157

Abstract

AbstractCentral nervous system (CNS) tumors are the most common solid tumors in children and adolescents. However, in neonates and children aged younger than a year, they are very rare. Clinical presentation in neonates is often subtle and nonspecific. When neurological symptoms are apparent at this age, cranial ultrasound (CUS) is often done as the initial evaluation, with a standard approach through the anterior fontanel (AF), followed by further imaging, such as magnetic resonance imaging (MRI), if necessary. We report the first neonatal case of a rapidly progressive diffuse midline glioma positive for histone H3 K27M mutation (World Health Organization [WHO] grade IV) in which using extended (transmastoid) CUS studies through the mastoid fontanelle (MF) in the second month of life defined the lesion in the brainstem.

Highlights

Transcranial ultrasonography is a reliable, inexpensive, and noninvasive tool and often used for initial bedside diagnostics when neurological or nonspecific symptoms are apparent in neonates and infants in the first months of life
We report the first neonatal case of a rapidly progressive diffuse midline glioma positive for histone H3 K27M mutation (World Health Organization [WHO] grade IV) in which using extended cranial ultrasound (CUS) studies through the mastoid fontanelle (MF) in the second month of life defined the lesion in the brainstem
To perform the examination using the MF as an acoustic window, the examiner places the transducer in the mastoid area behind the ear and moves and changes direction until able to view the posterior fossa (PF)

Summary

Introduction

Transcranial ultrasonography is a reliable, inexpensive, and noninvasive tool and often used for initial bedside diagnostics when neurological or nonspecific symptoms (e.g., seizure, elevated anterior fontanel [AF], and lethargy) are apparent in neonates and infants in the first months of life. CUS Views in Infants with Acute Brain Stem or Infratentorial Lesions Lange et al e263. Experience an auditory response to pulses of radiofrequency energy which could cause discomfort.[5] For this reason, the views through the MFs should be performed at the end of the examination. She showed signs of severe inspiratory stridor but otherwise uneventful clinical and neurological examination. Point of care ultrasound was performed and showed a heteroechogenic lesion in the brain stem (►Fig. 3A). Standard CUS window via the AF demonstrated enlarged lateral ventricles but was unable to visualize the infratentorial structures. The mass was suspected to be a brain stem glioma with secondary obstruction of the third ventricle (►Fig. 3A and 3B)

Case Presentation

Conclusion