Infection Mimics with Brainstem Presentation

The brainstem and cerebellum are two infratentorial locations that are commonly involved in demyelinating disorders. Diagnosis of demyelinating lesions of the brainstem and cerebellum mostly depends on ruling out mimics including tumors, vascular lesions, and infections. Certain infections such as Listeria, enteroviruses, and herpes viruses have the propensity to affect the brainstem and thus are often confused with demyelinating lesions. Tuberculosis, neurocysticercosis, toxoplasmosis, cryptococcosis, and histoplasmosis on the other hand are infections that are not restricted to the brainstem or cerebellum but can give rise to lesions with similar-appearing rim-enhacement and thus can also be misinterpreted as demyelinating lesions when affecting those anatomical locations. . Stereotactic biopsy of the brainstem is controversial but is a reasonable option to consider when arriving at a diagnosis from clinical and radiological features alone is not possible.