Vague headache for 3 months. Acute deterioration with vomiting. No neurology.
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A huge mass centred on the pons - it expands the brainstem with mass effect on the 4th ventricle, extends into the cerebral peduncles and anteriorly around the basilar artery. The lateral and third ventricles are dilated with prominence of the temporal horns.
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This child presented with a long history of headache with superimposed acute deterioration. The huge pontine glioma shows that large tumours can grow to a significant size without resulting in significant symptoms.
Despite relatively few symptoms over time, the tumour eventually completely obstructs CSF flow and results in hydrocephalus with symptoms of raised intracranial pressure.
The child needs a neurosurgical review and consideration of a ventricular access device to reduce the pressure.
The hydrocephalus in this case is relatively mild without periventricular oedema.