Abstract and Figures

This report presents a rare case of a 19-year-old male with bilateral periventricular nodular heterotopia (PVNH), a congenital brain abnormality resulting from failed neural cell migration, along with an intra-axial pontine lesion of unknown pathology. The differential diagnosis of childhood brainstem tumors in such cases commonly includes diffuse midline glioma (DMG), which is associated with a dismal prognosis due to H3 K27 gene mutation. However, this case exhibits a unique focal dorsal exophytic brainstem glioma variant, accounting for only a small percentage (approximately 10%) of pontine tumors and carrying a more favorable prognosis. The lesion is suspected to be a pilocytic astrocytoma, presenting distinct neurological symptoms. In this case, the patient presented with symptoms include mainly occasional tonic-clonic seizures, right side mild spasticity with ataxic gait and right eye blurring of vision along with right side facial palsy . The patient’s clinical evaluation, in conjunction with various medical diagnostic tests and MRI with and without contrast, led to the final diagnosis. Management began with anti-epileptic medication, with a plan for further treatment and follow-up.