44-YEAR-OLD MAIM WITH ABNORMAL GAIT

摘要

A 44-year-old man was hospitalized with an acute onset of giddiness, drunken gait and tendency to fall. He was apparently well until 1 week prior to presentation. He experienced these symptoms after drinking heavily at a party. There was no history of trauma, headache, vomiting or seizures.On neurological examination, there was no motor or sensory deficit. Finger-to-nose testing revealed mildly abnormal coordination. The patient tended to sway and fall ^rdeways on heel-to-toe walking. Romberg's test was mildly positive. Meningeal signs were absent.Computed tomography (CT) scan revealed a large hyper-dense calcified lesion in the fourth ventricle. Magnetic resonance imaging scans showed a fourth ventricular space-occupying lesion with mild hydrocephalus. Craniectomy with endoscopic fourth ventriculostomy was performed. A reddish brown tumor mass wasencountered measuring 30 mm x 20 mm attached to the floor of the fourth ventricle. The tumor was almost entirely resected.Histopathological examination revealed a moderately cellular tumor with large areas of calcification (Figures 1 and 2). The tumor cells were arranged in groups and cords as well as showing papillary formation in many areas. The tumor cells were generally large and contained brightly eosinophilic granular cytoplasm with central nuclei (Figure 3). There was only mild nuclear pleomor-phism and mitoses were rare.