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General Pediatric Brain Tumor

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• Signs & Symptoms

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Home > Disclaimer > Medulloblastoma > Signs & Symptoms

Patients with medulloblastoma usually present with a short history of problems (1-2 months).

Generally related to increased intracranial pressure or cerebellar dysfunction.

Increased Intracranial Pressure

Blockage of the ventricles by the tumor results in the build-up of CSF in the skull.

Symptoms of hydrocephalus are age-related.

An increase in head circumference may be the only presenting sign in an infant

Very young patients have increased head circumference, behavioral changes such as irritability, vomiting, and decreased social interaction.

An increase in head circumference is often the only presenting symptom in infants. These infants can be found with full anterior fontanelles and widely split cranial sutures. Older children and adults suffer from

• Headache
• Vomiting (in the absence of nausea is common in the morning due to the recumbent increase in intracranial pressure at this time).
• cranial nerve palsies (most commonly VI cranial nerve.  Hydrocephalus causes compression of cranial nerve VI at the petroclival ligament, resulting in diplopia, medial deviation of the affected eye and lateral gaze paresis).

Cerebellar Symptoms

• Involvement of the cerebellar vermis may cause truncal ataxia or wide-based gait.
• Unilateral cerebellar symptoms are more common with the desmoplastic variety of medulloblastoma as this arises in individual cerebellar hemispheres.
• Nystagmus is associated with lesions of the cerebellar vermis.

Head tilt and neck stiffness may also occur as the result of meningeal irritation.

• Rarely tonsilar herniation may occur below the foramen magnum and cause neck stiffness.This is a very serious life threatening complication and the patient may quickly become obtunded
• Head tilt may also result from trochlear nerve palsy caused by direct tumor compression.

Leptomeningeal Dissemination

• Medulloblastoma has a significant risk of dissemination within the CSF (roughly 30%).
• Patients very rarely have symptoms related to this at presentation.
• On relapse, patients are more likely to have symptoms of spinal cord compression (weakness, numbness, bowel or bladder changes) due to tumor compression of the spinal cord or nerve roots.

Table. Symptoms associated with medulloblastoma.

Complication	Associated Symptom(s)
Increased intracranial pressure	Hydrocephalus: -headaches (more severe in morning) -vomiting (more severe in morning) -papilledema -lethargy Cranial Nerve Palsies Visual disturbances Increased head circumference (infants) full anterior fontanelles widely-split cranial sutures
Cerebellar Invasion	Truncal ataxia Wide-based gait
Leptomeningeal dissemination	Rarely have symptoms related to this May have weakness due to compression of spinal cord or nerve roots

Published: November, 2007