Spinal Metastases in Diffuse Intrinsic Pontine Glioma: A Rare Presentation of Rapid Neurological Decline.

A nine-year-old male patient with a history of diffuse intrinsic pontine glioma (DIPG) presented with an episode of acute neurological deterioration approximately 18 months following completion of a primary course of radiation therapy to the brainstem for DIPG. His symptoms at that time included weakness in the lower extremities, urinary incontinence, and respiratory failure. Magnetic resonance imaging of the brain, cervical, thoracic, and lumbar spine revealed progression of the disease with metastatic deposits involving the craniospinal axis. He subsequently underwent a course of salvage radiation therapy to the craniospinal axis. This case highlights a rare but severe manifestation of metastatic DIPG with spinal involvement.