Ataxia and hydrocephalus as a symptom of presentation of a cerebral glioma

Abstract

Brainstem tumors constitute 10-25% of pediatric brain tumors. Focal gliomas of the midbrain are a distinct subgroup and constitute between 9-10% of the total trunk tumors in children. They give rise to manifestations related to obstructive hydrocephaly and must be taken into account in the case of obstructions of the late-onset Silvio aqueduct, when undergoing in 10% of them. MRI is the diagnostic test of choice. The diagnosis of “benign tectal glioma” is usually made based on the radiological appearance and the indolent course of these lesions. If hydrocephalus is treated properly, the overall prognosis is excellent. Given the usually benign course of tectum gliomas, most patients can be followed with periodic MRI without specific tumor treatment. Endoscopic ventriculostomy is the treatment of choice for hydrocephalus. Motor clumsiness and ataxia are described as presenting symptoms of tectum tumors, although studies describing tremor with underlying hydrocephalus are scarce. We present a patient with motor clumsiness, tremor, and altered intellectual functioning in relation to chronic obstructive hydrocephalus and mesencephalic lesion compatible with tectal glioma. The diagnosis was made with MRI, and treatment with endoscopic ventriculostomy was performed, with good clinical evolution. It is essential to keep in mind the possibility of a hydrocephalus and an underlying mesencephalic tumor before any pediatric patient with symptoms of motor clumsiness, especially if he associates symptoms of low cognitive performance.