This 12-year-old boy presented with a one-month history of intra-cranial raised pressure syndrome, characterized by headache and vomiting, followed by nuchal pain and torticollis. Physical and neurological examinations were normal except for papilledema. No hereditary syndromes were disclosed.Brain MRI showed a35x30x26 mm a grossly round, irregularly shaped tumor mass of the posterior cranial fossa, hypo/isointense on Tl, iso/hyperintense on T2 and FLAIR, and heterogeneously enhanced by contrast medium (Figure 1). The tumor originated from the cerebellar vermis, extended into the paramedian region of the left cerebellar hemisphere, and compressed the fourth ventricle, causing triventricular hydrocephalus. Both spinal, infratentorial and supratentorial leptomeningeal tumor seeding were evident (Figures 2, 3). Moreover, within the left frontal lobe was present a strongly contrast-enhanced lesion considered as a possible metastasis (Figure 2).
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