Magnetic resonance imaging differential diagnosis of brainstem lesions in children

Abstract

Differential diagnosis of brainstem lesions, either isolated or in association with cerebellar and supra-tentorial lesions, can be challenging. Knowledge of the structural organization is crucial for the differential diagnosis and establishment of prognosis of pathologies with involvement of the brainstem. Familiarity with the location of the lesions in the brainstem is essential, especially in the pediatric population. Magnetic resonance imaging (MRI) is the most sensitive and specific imaging technique for diagnosing disorders of the posterior fossa and, particularly, the brainstem. High magnetic static field MRI allows detailed visualization of the morphology, signal intensity and metabolic content of the brainstem nuclei, together with visualization of the normal development and myelination. In this pictorial essay we review the brainstem pathology in pediatric patients and consider the MR imaging patterns that may help the radiologist to differentiate among vascular, toxico-metabolic, infective-inflammatory, degenerative and neoplastic processes. Helpful MR tips can guide the differential diagnosis: These include the location and morphology of lesions, the brainstem vascularization territories, gray and white matter distribution and tissue selective vulnerability.

Symmetrical Central Tegmental Tract Hyperintensity on T2-weighted Images in Pediatrics: A Systematic Review

“…Therefore, toxic-metabolic insult might be another noxious factor potentially leading to CTTH. This concept is also strengthened by evidence showing that medical treatment with VGB can be neurotoxic and can be associated to CTTH and to other MRI abnormalities especially of the basal ganglia [6], [7], [31], [32]. The VGBrelated MRI abnormalities can be reversible after drug discontinuation [6], [7], [31].…”

Acute brainstem haemorrhage as a presenting feature of high-grade glioma

“…The differential diagnosis of brainstem lesions in children includes neoplastic, vascular, infectious and postinfectious causes1 2 This case highlights that it is important to include high-grade glioma in the differential of acute brainstem haemorrhage and the essential role of biopsy in establishing the diagnosis.…”

Brainstem dysfunction in critically ill patients

“…The pyramidal and extrapyramidal tracts connect the upper motor neurons and the extrapyramidal nuclei with the lower motor neurons located in either the brainstem or the spinal cord [6]. While the former controls voluntary movement, the latter is involved in reflexes, motion, complex movements, and postural control (Tables 1 and 2).…”

“…When suspecting brainstem lesions, MRI will have the highest yield to further localize and characterize brainstem lesions [6] (Table 4). Evoked potentials may be also useful for detecting a brainstem lesion.…”