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Case Reports
. 2025 Mar 27;17(3):e81289.
doi: 10.7759/cureus.81289. eCollection 2025 Mar.

Spinal Metastases in Diffuse Intrinsic Pontine Glioma: A Rare Presentation of Rapid Neurological Decline

Grace E Markey  1 , Ramesh Boggula  1 , Ahmad Hammoud  1 , Steven R Miller  1
Affiliations
Case Reports

Spinal Metastases in Diffuse Intrinsic Pontine Glioma: A Rare Presentation of Rapid Neurological Decline

Grace E Markey et al. Cureus. .

Abstract

A nine-year-old male patient with a history of diffuse intrinsic pontine glioma (DIPG) presented with an episode of acute neurological deterioration approximately 18 months following completion of a primary course of radiation therapy to the brainstem for DIPG. His symptoms at that time included weakness in the lower extremities, urinary incontinence, and respiratory failure. Magnetic resonance imaging of the brain, cervical, thoracic, and lumbar spine revealed progression of the disease with metastatic deposits involving the craniospinal axis. He subsequently underwent a course of salvage radiation therapy to the craniospinal axis. This case highlights a rare but severe manifestation of metastatic DIPG with spinal involvement.

Keywords: brainstem tumor; conformal radiation therapy; craniospinal irradiation (csi); diffuse intrinsic pontine glioma; salvage radiation.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Axial T2 MRI showing a hyperintense brainstem lesion (A: yellow arrow) and T1 MRI displaying a subtle hypointense brainstem lesion (B: orange arrow). These MRI findings are consistent with a brainstem glioma.
Figure 2
Figure 2. Sagittal view of the radiation therapy treatment plan to the brainstem.
Gross tumor volume (GTV) is the brown contour; planning target volume (PTV) is the dark blue contour; green contour is the 95% isodose line; yellow contour is the 80% isodose line; magenta contour is the 50% isodose line
Figure 3
Figure 3. Sagittal T2 MRI with the yellow arrow pointing to the hyperintense extramedullary tumor involvement of the thoracic and lumbar spine and a green arrow pointing to intramedullary involvement of the lumbar spine with metastatic disease. The spinal cord is hypointense in this image.
Figure 4
Figure 4. Axial T2 MRI showing metastasis (hyperintense area - blue arrow) compressing the thoracic spinal cord (hypointense area - outlined in white dots) again demonstrating disease progression with resulting lower and upper extremity weakness.
Figure 5
Figure 5. Sagittal view of craniospinal irradiation minimizing the dose to the brainstem.
The 4000 cGy isodose line is green; the 5000 cGy isodose line is yellow; the 6000 cGy isodose line is dark blue
Figure 6
Figure 6. Dose volume histogram of the organs at risk.
Blue indicates the brainstem; green indicates the spinal cord; red indicates the optic chiasm; orange indicates the kidneys
Figure 7
Figure 7. Sagittal T2 MRI showing tumor progression (yellow arrows)
See this image and copyright information in PMC

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