Neurologic Manifestations of Ependymoma Clinical Presentation

Updated: Mar 19, 2019
  • Author: Subrata Ghosh, MD, MBBS, MS; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Presentation

History

Presenting features are insidious and progressive in nature.

  • Nausea and vomiting (80%) is the most common presenting symptom, secondary to increased intracranial pressure.

  • Headache (60%), due to the local effect of pressure or increased intracranial pressure, is usually worse in the morning.

  • Change in behavior (50%) includes lethargy, irritability, diminished social interaction, and loss of appetite (prevalent in younger children).

  • Difficulty with balance (30%) reflects cerebellar involvement or mass effect.

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Physical

See the list below:

  • Papilledema (60%)

  • Ataxia (45%)

  • Nystagmus with or without gaze palsy (40%)

  • Lower cranial nerve palsies (10%)

  • Apraxia or hemiparesis (20%)

  • Increase in head circumference in children younger than 2 years (10%)

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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.

  • Other diagnostic considerations:

    • Meningitis

    • Encephalitis

    • 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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