Case of the Day(sm)

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Woman fell, brought to ER.

Our appreciation is extended to Dr. Parin Bhayani,
Indiana University Department of Radiology,
for contributing this case.

History: Woman fell, brought to ER.

Click these images to enlarge them.

Which choice best localizes the salient abnormality?

Ventricles.Tectum.Thalamus.Suprasellar cistern.Periventricular grey matter.

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Case of the Day(SM) Copyright

Case of the Day(sm)

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Woman fell, brought to ER.

Here are some MR images to correlate with the CT. Click to enlarge.

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Case of the Day(SM) Copyright

Case of the Day(sm)

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Woman fell, brought to ER.

Findings: CT demonstrates a soft-tissue mass near the tectal plate causing obstructive hydrocephalus. MRI demonstrates an intra-axial mass arising from the tectal plate and compressing the 4th ventricle causing obstructive hydrocephalus. The mass is T2 hyper intense, T1 isointense and no significant contrast enhancement is seen. No surrounding edema.

Neurofibromatosis.

Differential diagnosis:

Tectal plate glioma (particularly low grade astrocytoma)
Pineal region masses (pineocytoma, germinoma, etc.)
Metastatic disease

Diagnosis: Tectal plate glioma

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Case of the Day(SM) Copyright

Case of the Day(sm)

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Woman fell, brought to ER.

Key points:

The tectum (also known as the quadrigeminal plate) is the dorsal part of the midbrain and consists of the superior and inferior colliculi and periaqueductal gray matter.
Masses arising from this region are primarily brainstem gliomas.
- Approximately 50% of brainstem gliomas are low grade astrocytomas.
These masses are predominantly T2 hyper intense with variable enhancement patterns.
Even the small tectal gliomas can obstruct the cerebral aqueduct and cause obstructive hydrocephalus
Brainstem gliomas are associated with neurofibromatosis type I
Prognosis is good especially when it's a focal, low-grade glioma
- Treatment with shunting of hydrocephalus and surgical resection +/- chemotherapy.

References: