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Medulloblastoma, hemispheric

CLINICAL HISTORY:
This 8-year old child shows painless torticollis of one week, with deviation of the head to the right. He complains of slight headache. Now several episodes of vomiting have occured.

NEUROLOGICAL EXAMINATION shows instability of gait with positive Romberg sign to the left. There is left dysmetria, dysdiadochokinesia and nystagmus at left lateral gaze.

MRI:
a) TRANSAXIAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGE 1): A hyperintense mass (arrowheads) lesion is seen in the left cerebellar hemisphere. The fourth ventricle (arrow) is displaced to the right. Clear compression on the left lateral pons is noted, with hyperintensity.

b) TRANSAXIAL T1-WEIGHTED (520/15/1) SPIN-ECHO SEQUENCE (IMAGE 2): The mass is homogeneously hypointense.

c) TRANSAXIAL (IMAGE 3) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: Little or no enhancement of the tumor is appreciated.

RADIOLOGICAL DIFFERENTIAL DIAGNOSIS includes pilocytic astrocytoma of the cerebellum, hemispheric medulloblastoma or brainstem glioma.

SURGICAL FINDINGS: At surgery, a voluminous grey-purple mass with soft consistency was found occupying at least half of the cerebellar hemisphere. The lesion invaded the middle cerebellar peduncle and medially reached the fourth ventricle. Resection was partial, because of brainstem invasion.

ANATOMOPATHOLOGY: Medulloblastoma.

Treatment was completed with radiotherapy.

COMMENT: Ten months later the patient again complained of headache and gait instability.

CT:
a) NON-CONTRAST SCAN (IMAGE 4): A mass lesion is seen in the left cerebellar hemisphere, with displacement of the fourth ventricle to the right.

b) CONTRAST-ENHANCED SCAN (IMAGE 5): Moderate enhancement of the lesion is noted, with evidence of some intratumoral cysts.

MRI:
a) TRANSAXIAL T1-WEIGHTED (600/15/1) SPIN-ECHO SEQUENCE (IMAGE 6): The lesion again can be seen in the left cerebellar hemisphere.

b) TRANSAXIAL (IMAGE 7) AND CORONAL (IMAGE 8) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: This time the tumor shows intense enhancement.

Diagnosis is made of local recurrence of medulloblastoma. The patient died three months after this diagnosis.

Search also:
Medulloblastoma

 

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Fig. 1

Medulloblastoma, hemispheric, Fig. 1
Medulloblastoma, hemispheric, Fig. 2
Medulloblastoma, hemispheric, Fig. 3
Medulloblastoma, hemispheric, Fig. 4
Medulloblastoma, hemispheric, Fig. 5
Medulloblastoma, hemispheric, Fig. 6
Medulloblastoma, hemispheric, Fig. 7
Medulloblastoma, hemispheric, Fig. 8