A 34-year-old patient presented with visual disturbance, headache, and vomiting. Physical examination revealed severe hypertension (RR_systolic 240 mm Hg) with secondary organ manifestations (hypertensive cardiomyopathy, renal failure, and hypertensive retinopathy). MR imaging showed T2/fluid-attenuated inversion recovery hyperintensities in the cerebellar peduncles, pons, and medulla oblongata with a space-occupying effect and point-shaped contrast enhancement on contrast-enhanced T1-weighted images, suggestive for brainstem gliomas (Figure, A–C). MR spectroscopy indicated a reduced ratio of N-acetylaspartate (NAA)/creatine and NAA/choline, atypical for gliomas (Figure, D). CSF examination was unremarkable.

一名 34 岁患者出现视力障碍、头痛和呕吐。体检发现严重高血压（RR_收缩压240 mm Hg）并伴有继发器官表现（高血压心肌病、肾功能衰竭和高血压视网膜病变）。MR 成像显示小脑脚、脑桥和延髓中存在 T2/流体衰减反转恢复高信号，在对比增强 T1 加权图像上具有占位效应和点状对比增强，提示脑干胶质瘤（图 A -C）。磁共振波谱显示 N-乙酰天冬氨酸 (NAA)/肌酸和 NAA/胆碱的比率降低，这对于神经胶质瘤来说是非典型的（图 D）。脑脊液检查无异常。