Ventrally exophytic pontine mass in a patient with dysarthria, dysphagia and diplopia – Question

Abstract

A 44-year-old man with no significant past medical history presented with a one-month long history of dysarthria, dysphagia and diplopia of left lateral gaze. Examination showed a left abducens nerve palsy and hemifacial numbness. He was hyper-reflexic in the upper and lower limbs on the right side, with bilateral ankle clonus and upgoing plantar reflexes. Routine blood tests showed no abnormalities. Magnetic resonance imaging (MRI) of the brain demonstrated a large ventral pontine mass extending to the left cerebellopontine angle (Fig. 1A). The lesion demonstrated moderately high signal on FLAIR sequences (Fig. 1B) and intermediate to low signal on T1 weighted images. Internal cystic components were seen, and the mass demonstrated patchy contrast enhancement (Fig. 1C). There was no associated diffusion restriction. Encasement of the basilar artery was noted without loss of the flow void. The most likely diagnosis is:A)Left Abducens Nerve SchwannomaB)High Grade GliomaC)SarcoidosisD)Serpentine Fusiform Basilar Artery AneurysmE)Epidermoid CystF)Exophytic Pilocytic Astrocytoma Answer on page: 310. Both C.O and T.O conceptualised the paper. C.O prepared the initial draft. This draft was revised based on input from T.O and S.S.