One Report And Analysis Of Brainstem Glioma Misdiagnosed To Clinically Isolated Syndrome

Objective Understanding that Clinically Isolated Syndrome(CIS) represents initial onset of many demyelinating diseases,besides other diseases.The pathogenesy of Clinically Isolated Syndrome cannot be explained well,the major clinical types are optic neuritis,isolated brainstem lesion and spinal cord partial lesion.There is no unified diagnostic criteria for Clinically Isolated Syndrome,the patterns of manifestation are multiple and untypical,we must inquire patient history in detail,complete physical examination and connect with relative auxiliary examination such as:the tests of cerebrospinal fluid,visually-evoked potential,magnetic resonance imaging and enhancement scanning,and so on,to complete early diagnosis and differential diagnosis,especially pay attention to the differences between the isolated brainstem demyelinating disease and untypical brainstem gliomas.We should realize that the possibility for Clinically Isolated Syndrome converting to Multiple Sclerosis(MS) is much higher than others and know that the possible factors which may affect the risk of Clinically Isolated Syndrome converting to Multiple Sclerosis,through the clinical data related to auxiliary examination,and the view of advocating early diagnosis,early therapy and early medication to delay the progression and to prevent relapse are significant.Method Report and analyse the case of brainstem glioma which was misdiagnosed to Clinically Isolated Syndrome(CIS) in following areas:the clinical manifestations,auxiliary examinations,diagnosis,differential diagnosis,major therapy,progression,prognosis and SO on.Discussion The differential diagnosis between the brainstem type of Clinically Isolated Syndrome and untypical brainstem glioma should be discussed.The two diseases may have similar clinical manifestations,similar imaging tests and similar somatosensory evoked potentials,effective hormone therapy.In this case,because of brainstem edema obvious which had compressed the fourth ventricle of cerebrum,the lumbar puncture could cause cerebral hernia to threat to life,so we didn't complete examination of cerebrospinal fluid,this maybe one reason for misdiagnosis.We should pay attention to the prognosis,long term follow-up and rechecking magnetic resonance imaging to make a definite diagnosis.Differential focal changes, differential pathogenetic condition changes and therapeutic efficacy,differential prognosis are not only helpful to make a definite diagnosis,but also helpful to identify whether Clinically Isolated Syndrome will progress to Multiple Sclerosis.It is very important for the early diagnosis and therapy of Multiple Sclerosis.Conclusion When we diagnose the brainstem type of Clinically Isolated Syndrome,we should inquire patient history in detail,whether this episode is first time,especially pay attention to whether slight symptoms relieved soon,ignored easily and reflecting neurological disfunction appear before the episode.Although Magnetic Resonance Imaging,Cerebrospinal Fluid tests,Evoked Potentials and other tests can cxclude other infectious diseases involved in central nervous system(such as Lupus Erythematosus Systemic,neurosyphilis ),Multiple Sclerosis,Acute Disseminated Encephalomyelitis,we should make a differential diagnosis between Clinically Isolated Sclerosis and brainstem occupying lesion,which need recheck the Magnetic Resonance Imaging to observe the changes of the lesion after a long term follow-up for the final diagnosis.Analysing the clinical manifestations and auxiliary examinations as Magetic Resonance Imaging,Cerebrospinal Fluid tests etc,we can predict probably the conversion and the prognosis of the Clinical Isolated Syndrome,and advocate early diagnosis,early therapy and early medication to delay the progression and to prevent relapse,after a long term follow-up, especially for those patients having a high risk in converting to Multiple Sclerosis.Now the definitely clinical index of judging conversion and evaluating prognosis of CIS is deficient,so we need further investigation.