Pontine mass presenting as anxiety, obsessions, and severe eating problems: a case report

Pediatric Obsessive-Compulsive Disorder Exacerbation and Obstructive Hydrocephalus: A Case Report

We present the case of an 11 year-old boy with a previous history of obsessive-compulsive disorder (OCD), who experienced a dramatic and acute worsening of OCD symptoms in temporal association with obstructive hydrocephalus secondary to a tectal low-grade glioma. Management and resolution of the hydrocephalus was temporally associated with an improvement in his OCD compulsion symptoms. The present case does not establish proof of cause and effect, but highlights potential multifactorial influences on OCD onset and clinical course. Cortico-striatal-thalamic-cortical pathways, physically distorted by hydrocephalus in this case, have long been implicated in OCD etiology. Clinical implications include the importance of conducting an appropriate neurologic work-up to rule out biological causes for acute and dramatic OCD exacerbations with neurologic signs, even in the context of preexisting OCD. Given that neurologic lesions may exist in the absence of typical signs and symptoms, that they may further disrupt OCD circuitry, and that treatment may lead to resolution of associated psychiatric symptoms, it is important to remain cognizant of these differential diagnoses.

Brainstem gliomas in children and adults

PURPOSE OF REVIEW

The purpose of this review is to determine if recent advances in diagnostic and treatment modalities result in improvement in the pattern of care of brainstem gliomas.

RECENT FINDINGS

New MRI techniques may contribute to differential diagnosis and aid neurosurgeons in removing resectable brainstem tumors. A better radiological analysis of these heterogeneous tumors improves their classification and helps to better distinguish prognosis subgroups. However, biopsy remains indicated in many contrast enhancing brainstem masses in adults because of the great variety of differential diagnosis.

SUMMARY

Diffuse brainstem glioma is the most common subtype of brainstem tumor and remains a devastating malignancy in children. Conventional radiotherapy is the standard of care and chemotherapy has been disappointing to date. Given the lack of efficacy of conventional drugs, a better understanding of the biology of this tumor is the key to more targeted therapy.