History
Presenting features are insidious and progressive in nature.
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Nausea and vomiting (80%) is the most common presenting symptom, secondary to increased intracranial pressure.
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Headache (60%), due to the local effect of pressure or increased intracranial pressure, is usually worse in the morning.
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Change in behavior (50%) includes lethargy, irritability, diminished social interaction, and loss of appetite (prevalent in younger children).
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Difficulty with balance (30%) reflects cerebellar involvement or mass effect.
Physical
See the list below:
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Papilledema (60%)
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Ataxia (45%)
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Nystagmus with or without gaze palsy (40%)
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Lower cranial nerve palsies (10%)
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Apraxia or hemiparesis (20%)
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Increase in head circumference in children younger than 2 years (10%)
Causes
No particular genetic or molecular marker or familial predisposition has been identified for this tumor type. In one series, only a few ependymomas were reported to be hyperdiploid or tetraploid.
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Other diagnostic considerations:
Other brain tumors (astrocytoma, medulloblastoma, oligodendroglioma)
Meningitis and encephalitis can be readily differentiated by their more abrupt onset, associated fever, or signs of meningeal irritation.
Differentiation from other types of brain tumors (astrocytoma, medulloblastoma, oligodendroglioma) is radiological and pathological.
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CT scan without contrast, axial view, demonstrates mixed but predominantly hyperdense tumor in the posterior fossa with severe obstructive hydrocephalus.
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CT scan with contrast, axial view shows moderately intense contrast enhancement (compare with the previous image).
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MRI, T2-weighted image, axial view, showing mixed (isodensity and hyperdensity) heterogenous nature of the tumor with some peritumoral edema.
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MRI, T1-weighted image, without contrast, sagittal view, showing the posterior fossa location, mixed (hypodensity and isodensity) signal intensity and tending to grow out of the fourth ventricle.
