Paediatric medulloblastoma with anxiety as primary presentation: A case report and review of literature

IntroductionAlthough paediatric medulloblastomas are well described in surgical literature, there is relatively little in child-and-adolescent psychiatry literature on them. Anxiety as the primary presenting complaint of a brain tumour, is rarely reported among the paediatric population with primary cerebral malignancy.ObjectiveTo highlight the prudence of an initial skeptical attitude towards the cause of symptoms, and also the importance of a comprehensive physical examination in child psychiatry units.MethodA 14 year-old Chinese boy is described, who presented at the outpatient psychiatric clinic with a 3-month history of increasing anxiety, difficulties with social interaction, deteriorating academic performance, interspersed with about two episodes of nausea per week. Previously, he was known as an intelligent boy who enjoyed a good relationship with his classmates. He has no other focal neurological deficits, and no recent life events were reported. A CT scan of the brain done revealed a large tumour distending the fourth ventricle. Histology revealed medulloblastoma.We will also briefly review the relevant literature.ResultsAfter surgical removal of the tumour, patient is described to be more participative in social interaction and almost back to his premorbid personality.ConclusionPrimary brain tumours may manifest only with psychiatric derangements. Somatic symptoms typically seen in anxious patients, such as nausea, may herald a more sinister underlying cause. We advocate further study on the relationship between anxiety and brain tumours, as well as urge an increased vigilance on the part of healthcare professionals in constantly utilizing a biopsychosocial diagnostic model in child-and-adolescent psychiatry.