scholarly journals Resolution of precocious puberty following resection of fourth ventricular medulloblastoma: case report

2015 ◽  
Vol 16 (3) ◽  
pp. 287-290 ◽  
Author(s):  
Renata G. Medina ◽  
David P. Dempsher ◽  
Karen M. Gauvain ◽  
Thomas J. Geller ◽  
Samer K. Elbabaa
Keyword(s):  
Posterior Fossa ◽  
Precocious Puberty ◽  
Fourth Ventricle ◽  
Laboratory Tests ◽  
Obstructive Hydrocephalus ◽  
Prior History ◽  
Neurosurgical Department ◽  
Blood Samples ◽  
Inferior Surface ◽  
History Of

Medulloblastoma is a malignant embryonal tumor that arises in the cerebellum and invades the fourth ventricle, often resulting in obstructive hydrocephalus. Patients typically present with symptoms related to increased intracranial pressure and cerebellar dysfunction. The authors report a rare case of classic medulloblastoma with central precocious puberty (CPP) as its only presenting symptom. A 7-year-old boy with no prior history of medulloblastoma presented with Tanner Stage IV testicular enlargement and a 4-month history of acne and pubic hair. Laboratory tests of blood samples demonstrated highly elevated luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone. Admission MRI of the brain revealed a mass in the posterior fossa, which bordered and compressed the fourth ventricle. The patient also exhibited mild lateral and third ventriculomegaly. Surgical options were discussed with the neurosurgical department. A suboccipital craniotomy and C-1 laminectomy were performed. A large mass was seen arising from the inferior surface of the vermis, and lying within the fourth ventricle. Gross-total microsurgical resection of the mass was performed. Histopathological investigation characterized the tumor as classic medulloblastoma. Follow-up laboratory tests of blood samples demonstrated a reduction of LH, FSH, and testosterone back to prepubertal levels. The patient then began radiation and chemotherapy. This report demonstrates that mild obstructive hydrocephalus due to a posterior fossa tumor may present with unexpected symptoms, such as CPP. To the authors’ knowledge, precocious puberty has not yet been associated with medulloblastoma, although it has been found with other posterior fossa tumors. Extensive imaging of the CNS for patients presenting with CPP is recommended.

Hemangioma Calcificans in the Fourth Ventricle

Neurosurgery ◽  
1984 ◽  
Vol 14 (6) ◽  
pp. 737-739 ◽  
Author(s):  
Kobayashi Hidenori ◽  
Kawano Hirokazu ◽  
Ito Haruhide ◽  
Hayashi Minoru ◽  
Yamamoto Shinjiro
Keyword(s):  
Computed Tomography ◽  
Intracranial Pressure ◽  
Posterior Fossa ◽  
Clinical Picture ◽  
Fourth Ventricle ◽  
Obstructive Hydrocephalus ◽  
Increased Intracranial Pressure ◽  
X Ray ◽  
4Th Ventricle

Abstract A case of hemangioma calcificans in the 4th ventricle is reported. Skull x-ray films demonstrated a dense calcification in the posterior fossa. Computed tomography disclosed a hyperdense mass in the 4th ventricle. The clinical picture was of increased intracranial pressure due to obstructive hydrocephalus. An hemangioma calcificans in the 4th ventricle was removed successfully.

Posterior Fossa Ependymoma

2019 ◽  
pp. 223-230
Author(s):  
Frederick A. Boop ◽  
Jimmy Ming-Jung Chuang
Keyword(s):  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Obstructive Hydrocephalus ◽  
Standard Of Care ◽  
Extent Of Resection ◽  
Clinical Findings ◽  
Current Standard ◽  
Subarachnoid Spaces ◽  
Growth Of Tumor ◽  
Foramen Of Luschka

Pediatric posterior fossa ependymomas are typically well-delineated masses with heterogenous enhancement arising from the floor, lateral aspect, or roof of the fourth ventricle. Growth of tumor into the posterior fossa subarachnoid spaces, particularly into the foramen of Magendie and the cerebellopontine angles via the foramen of Luschka, is a radiological hallmark of this tumor. Clinical findings of elevated intracranial pressure and obstructive hydrocephalus are common at presentation. The current standard of care for children with ependymoma consists of gross total resection with subsequent focal radiotherapy. The extent of resection is the single most important determinant of outcome. Hydrocephalus typically resolves after resection, and it is uncommon to require cerebrospinal shunt placement after tumor removal.

scholarly journals Vascular Headache: A Presenting Symptom of Multiple Sclerosis

1989 ◽  
Vol 16 (1) ◽  
pp. 63-66 ◽  
Author(s):  
Mark S. Freedman ◽  
Trevor A. Gray
Keyword(s):  
Multiple Sclerosis ◽  
Differential Diagnosis ◽  
Posterior Fossa ◽  
Severe Headache ◽  
Prior History ◽  
Initial Attack ◽  
Vascular Headache ◽  
Neurological Signs ◽  
History Of ◽  
Type Headache

ABSTRACT:Vascular headache of migraine-type may be a presenting symptom of multiple sclerosis (MS), a condition usually not considered in the differential diagnosis of a severe headache accompanied by neurological signs. We reviewed records of 1,113 patients with MS seen from 1967-1987 and found 44 cases whose initial attack or subsequent exacerbations were heralded by a migraine-type headache. Twenty-seven patients had no prior history of migraine, and of these, 12 presented simultaneously with their first headache and MS attack. Twenty-three patients had symptoms of a posterior fossa mass lesion. The significance of these results and possible pathogenesis is discussed.

Diffuse craniospinal seeding from a benign fourth ventricle choroid plexus papilloma

1998 ◽  
Vol 88 (4) ◽  
pp. 757-760 ◽  
Author(s):  
Richard Leblanc ◽  
Sabah Bekhor ◽  
Denis Melanson ◽  
Stirling Carpenter
Keyword(s):  
Choroid Plexus ◽  
Fourth Ventricle ◽  
Obstructive Hydrocephalus ◽  
Choroid Plexus Papilloma ◽  
Blurred Vision ◽  
Content Type ◽  
Biological Potential ◽  
History Of ◽  
Fine Print ◽  
Plexus Papilloma

✓ Choroid plexus papillomas can metastasize to the subarachnoid space, but extensive metastasis has only been reported when the tumors are malignant. The authors report a case of diffuse, extensive metastasis to the craniospinal leptomeninges from a benign fourth ventricular choroid plexus papilloma in an adult. This 19-year-old woman presented with a 2-year history of headache, blurred vision, diplopia, and ataxia. Magnetic resonance imaging of the brain and spinal cord revealed obstructive hydrocephalus caused by a 4-cm, partially calcified, inhomogeneously enhancing tumor of the fourth ventricle that was displacing the pons, medulla oblongata, and cerebellum. Innumerable cystic lesions of varying size were also seen in the cranial and spinal leptomeninges. Histological examination of the resected fourth ventricular tumor and of a few of the leptomeningeal lesions revealed a benign choroid plexus papilloma and leptomeningeal choroid plexus cysts. This singular case of diffuse and extensive metastasis to the craniospinal leptomeninges from a histologically benign fourth ventricular papilloma adds to the available information about the biological potential of these tumors and expands the differential diagnosis of posterior fossa lesions with subarachnoid metastasis.

Early entrapment of fourth ventricle following Pseudomonas meningitis in extreme prematurity: Case report

2020 ◽  
Vol 13 (4) ◽  
pp. 581-586
Author(s):  
P.E. Edison ◽  
S.K. Sanamandra ◽  
V.A. Shah ◽  
V.R. Baral ◽  
C.L. Yeo
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Fourth Ventricle ◽  
Pediatric Population ◽  
Prior History ◽  
Extreme Prematurity ◽  
Early Course ◽  
History Of ◽  
Perinatally Acquired ◽  
Trapped Fourth Ventricle ◽  
Neuro Imaging

Trapped fourth ventricle (TFV) as a complication of post-hemorrhagic hydrocephalus (PHH) is widely reported in the pediatric population with a prior history of ventriculo-peritoneal (VP) shunt placement. Characterized by disproportionate dilatation of the fourth ventricle on serial neuro-imaging, it is rarely encountered in the early course of preterm infants and the differentiating clinical features are subtle and non-specific. Clinical alertness and sonographic correlation hold the key to early diagnosis. We report an early emergence of TFV in an extremely low gestational age newborn (ELGAN) following fulminant Pseudomonas aeruginosa meningitis, approach to management, and the neurological outcome. Fourth ventricle entrapment as a complication of perinatally acquired Pseudomonas aeruginosa meningitis in a surviving ELGAN is extremely rare.

scholarly journals Cerebellar Medulloblastoma in Middle-to-Late Adulthood

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Majid Aljoghaiman ◽  
Mahmoud S. Taha ◽  
Marwah M. Abdulkader
Keyword(s):  
Brain Tumor ◽  
Intracranial Pressure ◽  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Obstructive Hydrocephalus ◽  
Signs And Symptoms ◽  
Raised Intracranial Pressure ◽  
Embryonal Tumor ◽  
Late Adulthood ◽  
Cerebellar Medulloblastoma

Medulloblastoma is a malignant brain tumor that is typically seen in children. It is classified as an embryonal tumor, classically located within the posterior fossa. When it involves the fourth ventricle, the patient commonly presents with signs and symptoms of raised intracranial pressure secondary to obstructive hydrocephalus. It is exceedingly rare for Medulloblastoma to occur in middle and late adulthood. In this paper, we present a case of a 51-year-old man who presented with a posterior fossa mass that was diagnosed later as Medulloblastoma.

scholarly journals Intraventricular adult Taenia solium causing hydrocephalus: A case report

2020 ◽  
Vol 11 ◽  
pp. 202
Author(s):  
Ketan Yerneni ◽  
Constantine Karras ◽  
Hannah K. Weiss ◽  
Craig M. Horbinski ◽  
Orin Bloch
Keyword(s):  
Fourth Ventricle ◽  
Obstructive Hydrocephalus ◽  
Taenia Solium ◽  
Parasitic Infection ◽  
Cystic Mass ◽  
Third Ventriculostomy ◽  
Unexpected Finding ◽  
Adult Onset ◽  
Larval Form ◽  
History Of

Background: Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system worldwide and is caused by the larval form of the tapeworm Taenia solium. In general, T. solium larval form may be located in the neuraxis, resulting in pathology. Here, we report a rare case of female with a history of adult onset seizures presenting with adult form T. solium in the fourth ventricle, causing hydrocephalus. Case Description: A 36-year-old female patient with a known history of adult onset seizures presented with a 1-year history of progressively worsening bilateral headaches with vertigo and intermittent nausea. A computerized tomography scan revealed ventriculomegaly and transependymal flow, with an obstruction at the level of the fourth ventricle. Outpatient magnetic resonance imaging demonstrated obstructive hydrocephalus secondary to a lobulated cystic mass within the fourth ventricle, demonstrating a gross appearance consistent with racemose NCC. The patient underwent endoscopic third ventriculostomy, and gross examination of the resected cyst revealed a mature T. solium larvae encased in a cystic membrane. Given that our patient was born and raised in Mexico but had not returned since the age of 8, NCC was an unexpected finding. Conclusion: The present case highlights the importance of maintaining high suspicion for NCC in all patients presenting with seizures or hydrocephalus of unknown cause. Even in patients with a very remote history of residence in an endemic country, NCC can be an overlooked, underlying cause of both chronic neurologic symptoms, as well as acute, life-threatening neurologic emergencies.

Primary hypertension—induced cerebellar encephalopathy causing obstructive hydrocephalus

2003 ◽  
Vol 98 (6) ◽  
pp. 1307-1311 ◽  
Author(s):  
Meg Verrees ◽  
Jose Americo Fernandes Filho ◽  
Jose I. Suarez ◽  
Robert A. Ratcheson
Keyword(s):  
Blood Pressure ◽  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Obstructive Hydrocephalus ◽  
Hypertensive Crisis ◽  
Systemic Blood Pressure ◽  
Neurological Status ◽  
Systemic Blood ◽  
Content Type ◽  
Fine Print

✓ Hypertension-induced encephalopathy is a recognized pathological process commonly focused in the parietal and occipital lobes of the cerebral hemispheres. The parenchyma of the posterior fossa is infrequently involved. The authors report on two cases of isolated edema of the cerebellar hemispheres, which occurred in the setting of hypertensive crisis and led to complete obstruction of or significant impingement on the fourth ventricle and potentially lethal hydrocephalus. To the best of the authors' knowledge, these are the first reported cases of hypertensive encephalopathy centered in the posterior fossa. Two patients presented with profound decreases in neurological status subsequent to development of malignant hypertension. Imaging studies revealed diffusely edematous cerebellar hemispheres with effacement of the fourth ventricle, causing dilation of the lateral and third ventricles. Following emergency placement of external ventricular drains, control of systemic blood pressure was accomplished, and neurological functioning returned to baseline. Although neurological deterioration resolved swiftly following placement of ventricular catheters and administration of diuretic agents, systemic blood pressure did not fluctuate with the release of cerebrospinal fluid and resolution of increased intracranial pressure. Decrease in systemic blood pressure lagged well behind improvement in neurological status; the patients remained morbidly hypertensive until systemic blood pressure was controlled with multiple parenteral medications. The authors hypothesize that the development of hypertension beyond the limits of cerebral autoregulation led to breakdown of the blood—brain barrier in the cerebellum and development of posterior fossa edema secondary to the focal transudation of protein and fluid. Correction of the elevated blood pressure led to amelioration of cerebellar edema. In the appropriate clinical setting, hypertension as the inciting cause of cerebellar encephalopathy should be considered.

Rapid expansion of a previously asymptomatic subependymoma

2005 ◽  
Vol 103 (6) ◽  
pp. 1084-1087 ◽  
Author(s):  
Adrian W. Laxton ◽  
Patrick Shannon ◽  
Sukriti Nag ◽  
Richard I. Farb ◽  
Mark Bernstein
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Posterior Fossa ◽  
Fourth Ventricle ◽  
Rapid Expansion ◽  
Histopathological Analysis ◽  
Resonance Imaging ◽  
Content Type ◽  
History Of ◽  
Fine Print

✓ This 39-year-old man presented with a 6-month history of occipital headaches. Magnetic resonance imaging revealed an irregularly shaped fourth ventricle mass. One month after his initial presentation, he was admitted to the hospital with significant tumor expansion and clinical deterioration. A posterior fossa craniectomy was performed and the mass was resected. Histopathological analysis of this tumor showed central necrosis with associated edema in an otherwise typical and benign-appearing subependymoma. To the authors' knowledge, this is the first reported case of rapid, nonhemorrhagic expansion associated with necrosis in a previously asymptomatic subependymoma.

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