Evaluate for infiltrative or neoplastic process. Left upper extremity weakness. Abnormal finding on Head CT. There is apparent diffuse enlargement of the brainstem with loss of the delineation of especially the inferior margin of the belly of the pons. There is mild T2 FLAIR hyperintensity within the central pons, accentuating hypointense transverse pontine fibers. FLAIR/T2 hyperintensity is also identified within the expanded and convex midbrain bilaterally. The cerebellar tonsils are normal in morphology, low normal in position. However, there is crowding of the foramen magnum. There is prominent near complete effacement of the prepontine cistern.There is no evidence of intracranial hemorrhage or acute infarct. There is a single punctate focus of T2/FLAIR intensity in the right frontal subcortical white matter. There is no abnormal intracranial enhancement. The ventricles are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact.
Diffuse symmetric expansion of the brainstem, particularly of the pons, with areas of T2 hyperintensity within the central pons and midbrain, concerning for an infiltrative process such as brainstem glioma. Differential diagnosis could include demyelinating disease and osmotic demyelination, if clinically applicable.Findings were discussed with Dr. Paul Kukulski, ER resident, at 11:30am on 10/21/16. 