Neuro Diseases: Brain Stem Glioma

Brain Stem Glioma is a tumor arising from the glial cells in the brain stem area. These glial tumors are mostly astrocytomas.

The brain stem consists of mid brain, pons and medulla oblongata from above downwards. Although this type of glioma can occur anywhere in the above 3 regions, however for whatever reasons it occurs most often in the pons area (pontine glioma). Also for whatever reasons, majority of these patients are children or people younger than 20. Of course it can rarely occur at any age.

Tumors result when there is pathological and unstoppable proliferation of cells. In the case of the above tumors it is not known what triggers this unrestrained cell growth.

Brain stem manifestations like cranial neuropathies (e.g. facial droop, eye lid drooping, double vision, difficulty with swallowing & speech), long tract signs like one sided (or some times both sided) paralysis of upper and/or lower extremities, up going big toe (babinski sign), sensory loss over the limbs and/or face etc are seen. As pointed above this type of tumor most often occurs in children so if a child presents with progressive neurological symptoms related to the brainstem area then clinically one of the possibilities to be considered is this tumor.

MRI of the brain with and without contrast is the single most important investigation to start with. A biopsy is generally necessary to confirm the diagnosis.

Surgical removal of the tumor tissue is very difficult with these tumors because of their location. Brain stem is difficult to access, also there are so many important brain centers in that area.

Radiation therapy and chemotherapy are the main therapeutic approaches to these patients. Generally the prognosis is not good as these tumors are cancers, also due to their location.

A pediatric and/or adult neurologist and neurosurgeons are frequently involved in the care of patients with gliomas in the Brain-Stem area of the brain.