PEDIATRIC BRAIN-STEM GLIOMAS WITH THE PREDOMINANT SYMPTOM OF SLEEP-APNEA

Two children complaining of sleep apnea presented with brain stem glio mas. In the early stage of their illness, neurological disorders were too subtle to be recognized as significant by the physicians or to be noted by the parents. Case 1 experienced an episode of unsteady gait a nd weakness in the bilateral alms, at the age of 5. When it recurred a fter 7 years of remission, the predominant symptom was sleep apnea. Ca se 2 exhibited nasality of speech as the earliest sign of his illness very early in his life, presumably 5 years before the diagnosis of bra in stem glioma. A slight sleep apnea which developed afterwards did no t draw attention of the physicians because no neurological signs other than paralyses of the bilateral soft palates were present. MRIs of th e both cases revealed diffuse, infiltrating lesions in the pens, the m edulla oblongata and the upper cervical spinal cord. Both cases shared some features: (1) diagnostic delay of several years from the first s ymptom; (2) the main lesion in the medulla oblongata, where important structures for respiratory control are identified, (3) infiltrative gr owth patterns in the MRI of the tumor, which might account for the unc ommon clinical courses.