Updated: 7/30/2019

Medulloblastoma

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Snapshot
  • A 5-year-old boy presents to his pediatrician with headache, nausea, and 2 episodes of emesis. His symptoms began approximately 1 month ago and his headache is most prominent in the morning. The patient also reports some mild fevers and chills. On physical exam, the patient has a wide-based gait with impaired heel-to-toe walking. Fundoscopy demonstrates bilateral papilledema. An MRI brain with intravenous contrast demonstrates a heterogenous midline lesion with hydrocephalus.
Introduction
  • Overview
    • neuroepithelial primary central nervous system (CNS) tumor arising from the posterior fossa
  • Epidemiology
    • incidence
      • most common malignant primary brain tumor in pediatric patients
      • more common in males and in patients between the age of 1-10
  • Etiology
    • upregulation in WNT signaling
  • Prognosis
    • depends on a variety of factors such as age of diagnosis, residual deficits post procedure, histopathology, and biological/molecular markers
Presentation
  • Symptoms 
    • signs of increased intracranial pressure such as
      • morning headaches
      • nausea
      • vomiting
  • Physical exam
    • in midline lesions (e.g., cerebellar vermus lesion)
      • truncal ataxia (e.g., broad-based gait)
    • in cerebellar hemisphere lesions
      • appendicular ataxia (e.g., impaired finger-to-nose testing)
Imaging
  • MRI with and without intravenous contrast
    • indication
      • imaging study of choice for brain cancer
Studies
  • Making the diagnosis
    • based on clinical presentation and radiographic findings on MRI
Differential
  • Pilocytic astrocytoma
    • differentiating factor
      • cystic appearance on MRI
Treatment
  • Includes resection, radiation, and chemotherapy
Complications
  • Preoperative
    • neurological deficits due to hydrocephalus and intracranial posterior fossa lesion
 

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