703 - Ataxia and Bilateral Ptosis Following Resection of Midbrain Pilocytic Astrocytoma

Case Diagnosis: Pilocytic Astrocytoma

Case Description: 23 yo M with a PMHx of mastoiditis who presented to an acute care hospital with complaints of frontal headache and dizziness. CTH on admission revealed a heterogenous mass with calcification in the midbrain, compressing the cerebral aqueduct, dilatation of the bilateral lateral and third ventricles causing obstructive hydrocephalus and inferior cerebellar tonsillar herniation 5mm below the foramen magnum. He underwent a right craniotomy for tumor resection and EVD placement. Post-operatively his course was complicated by ataxia, right sided abducens palsy, bilateral diploplia, ventriculitis, paroxysmal sympathetic hyperactivity (PAH), central fevers, pneumonia, and paralyzed vocal cords. He was discharged to acute inpatient rehabilitation (AIR) as a minA/modA for bed mobility/transfers, modA for lower body dressing, and ambulated 5 feet from bed-chair. In speech therapy he had difficulty initiating voice independently and required max verbal/tactile cues.

Discussions: Pilocytic Astrocytoma (PCA) is the most common childhood brain tumor with an incidence of 0.8 in 100,000 people. They most often occur in the second decade of life and are found in the posterior fossa, but can also arise in the optic pathway, hypothalamus, cerebral hemispheres, spinal cord and brainstem. They are considered grade 1 gliomas which hold a good prognosis. There is a strong association between PCA and neurofibromatosis type 1. Most PCAs are considered sporadic. Secondary complications are usually dependent on location and can include hydrocephalus, peripheral ataxia, dysmetria, diplopia, intention tremor, seizures, nystagmus, dysarthria, broad-based gate, truncal ataxia, and titubation.

Conclusions: This case report emphasizes the difficulties associated with PCAs and the complications that may arise from the location of the tumor and surgical resection. Our patient made excellent gains in AIR where he was discharged home ambulating with a platform walker and custom ankle-foot orthosis. He also was nonverbal and, but at time of discharge, he was able to phonate.