Demyelinating disease as a differential diagnosis of diffuse midline glioma: report of two cases

The differential diagnosis between a demyelinating disease that affects the brain stem and a neoplasia in the same area is a diagnostic challenge for the clinician.The most useful, least invasive, and relatively available tool is magnetic resonance imaging of the brain.However, the diagnosis can be uncertain in some cases despite its use.On this occasion, we present the cases of two pediatric patients who presented these two types of conditions with similar clinical pictures.The first case deals with a 10-year-old patient who was admitted to the emergency room with hemiparesis, projectile vomiting, cranial nerve involvement, and a history of headache for 8 weeks, requiring a brain biopsy to conclude the diagnosis of a high-grade glioma.The second patient had a shorter course of 1 week with headaches, progressing to gait disturbance, and clinical data of affection to the cerebellum and cranial nerves.In this case, the image suggested a differential diagnosis between neoplasia and demyelination; due to the rapid and poor evolution of the patient, it was concluded that it was a demyelinating disease, and the indicated treatment was given with an adequate response.