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Updated: Dec 26 2021


  • 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
    • Pathogenesis
      • Upregulation in WNT signaling
  • 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
  • Prognosis
    • Depends on a variety of factors such as age of diagnosis, residual deficits post procedure, histopathology, and biological/molecular markers
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