We describe an 89-year-old woman who presented with an abrupt onset of
headache and right
hemiparesis. With the initial diagnosis of
cerebral infarction, we started
therapy using
sodium ozagrel. The right
hemiparesis worsened, however, and a continuous intravenous
heparin injection showed no effect. Furthermore, nystagmus in the bilateral eyes,
dysphagia, left
hemiparesis, and central ventilation disorder appeared one after another in three weeks. A magnetic resonance images (MRI) of the head, performed on the fifth hospital day with regular intervals of axial sections, disclosed no lesion responsible for right
hemiparesis. MRI of the brainstem and upper cervical cord, performed after two weeks with smaller intervals of axial sections, revealed a T2 high signal lesion in the left side of the medulla oblongata and upper cervical cord. After about five weeks from the onset of the disease, she died of
pneumonia. With the pathological examination, we diagnosed as
glioma originated in the left ventral part of medulla oblongata. Five similar cases of brainstem
glioma have been reported so far. Our patient, the oldest one, showed an exceptionally rapid
clinical course, instructing us to consider the possibility of medullary
glioma even in the elderly patients presenting with acute onset
hemiparesis followed by rapid and progressive appearance of brainstem signs.