![]() ![]() Upon neurological examination, no neurological defects of sensorium, cognition, cranial nerves, motor, sensory, cerebellar, gait, reflexes, meningeal irritation, or long tract signs were observed. Vital signs were within normal range, with body temperature of 37 ☌, pulse rate of 80 beats per minute, blood pressure of 120/70 mmHg, and respiratory rate of 16 breaths per minute. On physical examination, the patient’s weight and height were 50 kg and 162 cm, respectively. She lives in Hanoi and worked as an accountant with normal medical profile prior to this admission. The family members did not have any specific diseases and did not suffer from the same symptoms. She was a multi-para woman (gravida 2, para 2, living 2, abortion 0). The patient did not adopt any specific medications until hospital admission. We present the case of a 39-year-old woman who suffered from an extra-axial medulloblastoma with a remarkably low ADC located in the right CPA and retrospectively analyzed several reported cases of extra-axial medulloblastoma.Ī 39-year-old Asian woman presented to our hospital with symptoms including headache, dizziness, and right-sided hearing impairment, which she had experienced for some time but described as worsening starting 2 months prior to presentation. Although this neoplasm can present in both intra- and extra-axial locations, a very low apparent diffusion coefficient (ADC), to our knowledge, is unique to medulloblastoma. On radiographic examination, the most distinctive features used to distinguish medulloblastoma from other glial tumors are hyperdensity on computed tomography (CT) and restricted diffusion on magnetic resonance imaging (MRI), which are attributed to the high cellularity of medulloblastoma. Abducens nerve palsy may result from an extraventricular medulloblastoma extension. Truncal ataxia and spasticity are often indicators of tumors located in the vermis, whereas nystagmus and limb ataxia predominantly suggest a hemispheric location. Ĭlinical symptoms also vary on the basis of location, and patients often complain of headaches and persistent vomiting. On extremely rare occasions, medulloblastoma can be observed in an extra-axial location: the cerebellopontine angle (CPA) (86%), tentorial membrane (8%), or lateral hemispheric region of the cerebellum (6%). Medulloblastoma is thought to derive from primitive neuronal cells and is expected to be found in intra-axial locations of the brain and spine. Therefore, the vast majority of brain tumors have glial cell components medulloblastoma is an unusual exception owing to its neuronal cell origins. By contrast, neuronal cells are more stable and often do not divide after differentiation. Glial cells are typically viewed as supportive cells able to undergo cell division to replenish themselves after injury. When evaluating an atypical cerebellopontine angle neoplasm, the apparent diffusion coefficient should be considered a relevant indicator.Īt the most basic histological level, the human brain consists primarily of two components: neuronal cells and glial cells. We describe a rare example of extra-axial medulloblastoma, characterized by a low apparent diffusion coefficient. Pre- and postoperative magnetic resonance imaging revealed no drop metastasis, but adjuvant radiation therapy was still required as a standard treatment therapy ConclusionsĮxtra-axial medulloblastoma is an uncommon tumor that is often mistaken for other cerebellopontine angle neoplasms. However, the postoperative histopathologic findings indicated medulloblastoma (World Health Organization grade IV). ![]() The initial diagnosis suggested schwannoma or hemangioblastoma. A right extra-axial medulloblastoma with an extremely low apparent diffusion coefficient of 0.404 × 10 −3 mm 2/second was detected on magnetic resonance imaging. We present the unique case of a 39-year-old woman of Asian descent who suffered from headaches and right-sided hearing impairment. We believe that a thorough understanding of atypical medulloblastoma cases is important in daily practice. Extra-axial medulloblastoma is uncommon and often misdiagnosed. Medulloblastoma is well known as the most common malignant brain tumor identified in children, frequently found at an intra-axial location in the posterior cranial fossa. ![]()
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