Freiburg neuropathology case conference

Excerpt

A 7-year-old girl suffered from gait abnormalities, which had manifested several weeks previously with the result that the child was prone to falling. In addition, she reported problems to concentrate at school and had impaired coordination. More recently she had experienced brief episodes of slurred speech and double vision. A magnetic resonance imaging (MRI) of the brain depicted a large space-occupying lesion of the brain stem with signs of occlusive hydrocephalus. The patient was transferred to our university hospital and on admission presented with slurred speech and a skew deviation. The pupils were equally contracted and reactive to light. She had no motor weakness, symmetrically enhanced reflexes, a left-sided positive Babinski sign and the gait was atactic. After immediately starting therapy with dexamethasone the level of consciousness progressively deteriorated. An emergency compute tomography (CT) scan showed signs of increasing hydrocephalus. Due to the worsening of the patient’s consciousness level a ventriculoperitoneal shunt was implanted. Thereafter a stereotactic biopsy of the contrast-enhancing component of the brain stem lesion was performed via a left frontal trajectory, through the lateral ventricle and the third ventricle using a Leksell frame (Elekta, Stockholm, Sweden). After the biopsy the patient presented with slurred speech, a horizontal nystagmus and an impairment of eye movement to the left. In addition, she presented weakness of the left extremities. The neuropathological findings were discussed in our interdisciplinary pediatric tumor board and radiotherapy with concomitant chemotherapy (temozolamid) was initiated according to the HIT-HGG 2007 protocol. …