Adult Medulloblastoma: A Case Report of a Rare CNS Tumor

Neuromyelitis optica spectrum disorder (NMOSD) is a demyelinating disease caused by an autoantibody against the aquaporin-4 water channel. Typically, patients presents with vision loss secondary to unilateral or bilateral optic neuritis. We are reporting a case with a very unique presentation related to NMOSD.

Poster 171 Adult Medulloblastoma: A Case Report of a Rare CNS Tumor Chaow Charoenkijkajorn 1, Mohammad Pakravan 2, Noor Laylani 3, Pamela Davila 3, Matthew Cykowski 3, Peter Mortensen 3, Andrew Lee 4 Stanford School of Medicine, 2 UAMS College of Medicine, 3 Houston Methodist Hospital, 4 1. Center for Space Medicine, Baylor College of Medicine, Houston, Texas, United States 2. Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, United States 3. The Houston Methodist Research Institute, Houston Methodist Hospital, Houston, Texas, United States 4. Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, New York, United States 5. Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, United States 6. University of Texas MD Anderson Cancer Center, Houston, Texas, United States 7. Texas A&M College of Medicine, Texas, United States 8. Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States 1 Introduction: Medulloblastoma is an extremely rare CNS tumor in adults, with an incidence of 0.6 per 1,000,000 per year.1 Medulloblastoma primarily locate in the posterior fossa. Patients typically present with symptoms and signs of increased intracranial pressure, for example, headache, and nausea/vomiting. Neuro-ophthalmic manifestations can affect the afferent pathway (e.g.papilledema) and/or the efferent pathway (e.g.nystagmus, ocular motor nerve palsies).2 Description of Cases: 43-year-old female with past history of hypothyroidism on levothyroxine. presented with 1 week history of worsening occipital headache, nausea, and vomiting. She also reported light sensitivity, and poor vision on the current prescription. She has family history of pulmonary sarcoidosis in her maternal uncle. BCVA was 20/30 OD, and 20/40 OS. Pupil were reactive without RAPD. Slit-lamp examination was unremarkable, without disc edema. Extraocular motility was full. The MRI brain/orbit with/without gadolinium shows a left dural-based intraparenchymal cerebellar enhancing mass. CT chest/abdomen/pelvis revealed no lymphadenopathy or evidence of primary tumor. The ventriculoperitoneal shunt was placed. High dose intravenous steroid was given due to concern of neuroinflammatory diseases. Repeated MRI brain at 1 month showed increased enhancement in the cerebellum. Suboccipital craniotomy with gross total resection was performed. The histopathology shows WHO grade IV medulloblastoma, SSH positive, TP53-wild type. Following spinal imaging showed no drop metastasis. The patient developed upbeat nystagmus after the surgery. Adjuvant Chemotherapy with Vincristine, Lumustine, and Carboplatin and Proton craniospinal irradiation 3600 Gray plus 1800 brain boost were initiated, with stable course of disease. Conclusions, including unique features of the case: We present a diagnostic-challenging case of adult medulloblastoma presenting with increased intracranial pressure, light sensitivity, and developed upbeat nystagmus after surgery. Spinal imaging to look for drop metastasis is the crucial step in management. Molecular testing classifies the tumor into multiple subgroups with different prognosis, and provide information for specific targeted cancer therapy.3 References: None provided. Keywords: Tumors, High intracranial pressure/headache, Neuroimaging, Nystagmus, Miscellaneous Financial Disclosures: The authors had no disclosures. Grant Support: None Contact Information: Chaow Charoenkijkajorn, [e-mail] 2023 Annual Meeting Syllabus | 235