Brainstem Glioma

8-year-old female with a history of dysarthria and seizures. There is an infiltrative T1-hypointense, T2/FLAIR hyperintense mass within the left brachium pontis, left dorsal pons, and left dorsal medulla. The lesion demonstrates nodular and more curvilinear regions of enhancement without diffusion restriction. The differential diagnosis includes brainstem glioma, pilocytic astrocytoma, ependymoma and medulloblastoma. The findings are most compatible with a diffuse brainstem glioma, which account for about 1/4 of all posterior fossa tumors, and present most commonly between 7 and 9 years of age. Common clinical presentations include ataxia, cranial nerve palsies, long tract signs and hydrocephalus. Lesions can be associated with neurofibromatosis-1. Treatment and prognosis depends on tumor type and location.