The Most Common Malignant Brain Tumor in Children, But In A 55-Year-old Man

Introduction: We present a case of cerebellar medulloblastoma, a relatively common malignant brain tumor in children, but diagnosed in an older man presenting with acute onset dizziness. Although not the first case report of this disease, this is a rare case of medulloblastoma in an adult, accounting for less than 1% of all adult brain tumors (only about 200 are diagnosed annually). This case also highlights the symptoms and management of acute obstructive hydrocephalus. Case Description: A 55-year-old male presented to the ED with intermittent dizziness for the past month which had worsened, and associated with ataxia, headache, and confusion. Due to concern stroke, CT angiography of the head and neck was obtained, which demonstrated mass in the right cerebellum effacing the inferior 4th ventricle, with resultant obstructive hydrocephalus and cerebellar tonsillar herniation. Subsequent MRI demonstrated the classic findings of a medulloblastoma: a diffusion restricting and heterogeneously enhancing solid mass centered in the right cerebellar hemisphere, with associated adjacent cystic areas. The patient received steroids, mannitol, and hypertonic saline with improvement of symptoms, followed by excision of the mass. Subsequent pathology confirmed medulloblastoma. The patient's symptoms improved by the time of discharge. Discussion and Conclusion: This case report adds to the relative paucity of case reports in the literature regarding adult medulloblastoma, while also demonstrating the role imaging plays in patient care and management. Despite its rarity, this case showcases a very common presentation and history for this tumor, classic imaging findings, as well acute obstructive hydrocephalus management.