Case 355

An 8-year-old girl presented to the pediatrician with headaches that she had been experiencing for the last 2-3 years but that had become intolerable in the previous 8 days. The headaches were described by the patient as not having any lateralization and mainly involving the frontal and occipital regions. The headaches were rated by the patient as being an eight out of 10 in terms of pain, which prevented her from sleeping. Analgesic therapy proved to be ineffective. The patient had no photophobia or phonophobia but had increased fatigue alongside developing nausea without vomiting. The patient did not have any dysphagia, ataxia, vertigo, or elocution issues. Previous MRI performed in a provincial hospital showed a mass in the posterior fossa that was displacing the brainstem. However, being unable to get an appointment to see a neurosurgeon in a timely manner, the patient presented to the emergency department of our university hospital due to worsening symptoms. In order to exclude an intracranial origin of the symptoms, brain MRI with contrast enhancement was performed (Figure).