Subependymoma - 4th ventricle

Case contributed by Roberto Schubert

Presentation

Headaches and dizziness, otherwise healthy.

Patient Data

Age: 30 years
Gender: Male

MRI brain

mri

Midline mass in the inferior aspect of the 4th ventricle with hyperintense signal on T2- and iso- to slightly hypo-intense signal on T1-weighted images. No intralesional enhancement. No hydrocephalus. 

Annotated images

mri

The mass in the inferior aspect of the 4th ventricle (dashed blue line) is slightly hyperintense to the adjacent cerebellar cortex on T2 weighted images and isointense to cerebellar cortex on T1 weighted images, without convincing evidence of enhancement. 

The patient went on to have a posterior fossa craniotomy and excision of the lesion, confirming it to be a subependymoma. Follow up was obtained 6 months later. 

Postoperative follow-up 6 months later.

mri

No signs of residual or recurrent tumor after removal through a suboccipital craniotomy.

Case Discussion

This case exemplifies the difficulty in balancing various features pointing towards a diagnosis. The imaging features in this case are characteristic even though the age group is unusual. 

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