Adult Medulloblastoma Presenting With Audiovestibular Symptoms and an Alternating Unterberger Test

A man in his 30s presented with a four-week history of vertigo, unilateral tinnitus, and nausea on a background of a three-year history of asymmetric audiovestibular symptoms attributed to peripheral vestibular pathology. The neurological examination was normal. A brain magnetic resonance imaging (MRI) demonstrated a fourth ventricular enhancing tumour, which was resected. The final histology was classical medulloblastoma CNS WHO Grade 4. He received craniospinal irradiation and adjuvant chemotherapy. Two years after treatment, he relapsed with spinal drop metastases and received palliative treatment. This case highlights that adults with medulloblastoma may present atypically with a longer history of unusual audiovestibular symptoms rather than signs of raised intracranial pressure or brainstem/cerebellar dysfunction.