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Case Presentation: Pediatric Low-Grade Glioma
Patient Case
A 10-year-old girl presented to the emergency department with complaint of vision changes. She and her parents report that her eyes have not been tracking normally for the last 3 to 4 weeks. Additionally, she has had more frequent headaches over this timeframe, including some that occur early in the morning. She has not had any fever or other systemic signs of illness.
This patient was born full-term and has been a healthy child throughout her life. She has had normal growth and development. She is in the early stages of puberty (Tanner Stage 2) and has not experienced menarche. She takes ibuprofen as needed for headaches but does not take any other medications routinely. She does not historically have any vision concerns, and she has never seen an ophthalmologist but has passed vision assessments at school in prior years.
In the emergency department, this patient underwent a non-contrast head CT that demonstrated a brainstem mass and obstructive hydrocephalus. MRI brain with and without contrast was performed to better define the mass. The MRI confirmed a 3 x 4 cm solid mass extending posteriorly from the medulla causing compression of the 4th ventricle. The mass was T2-bright with heterogeneous contrast enhancement and no diffusion restriction. MRI of the spine done subsequently was normal.
This patient was admitted to the hospital for biopsy of the mass that confirmed a ganglioglioma, WHO grade I with a BRAF-V600E mutation. Additional surgical resection was determined to be too morbid.
