This child presented with a long history of headache with superimposed acute deterioration. The huge pontine glioma shows that large tumors can grow to a significant size without resulting in significant symptoms.

Despite relatively few symptoms over time, the tumor 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 edema.