This case involves an eight-month-old infant female who presented to her pediatrician with obstructive hydrocephalus due to a brainstem pilomyxoid astrocytoma. Prior to the neoplasm, the patient was otherwise healthy, meeting all developmental milestones at appropriate dates. At each visit, the pediatrician recorded weight and head circumference percentiles. The head circumference was consistent with what would be a red flag for hydrocephalus. The mother then brought the patient back to the physician’s office with poor feeding, vomiting, inability to hold head up, irritability, and crying. The provider recorded the incident as “poor feeding” and did not recommend a neurological evaluation. The patient’s mother returned yet again as her condition further deteriorated, and only when the mother noted drooping of the eyelid did the physician recommend a CT scan and neurological consult (on a non-emergent basis). At the mother’s insistence, the neurologist saw the patient the next day. He noted irritability and inability to palpate the anterior fontanel. The patient was then admitted to the hospital and seen by a neurosurgeon, who performed a right frontal craniotomy removing most of the benign tumor, which relieved the blockage. The entire tumor was not able to be removed, needing further treatment with chemotherapy. Ongoing problems included the inability to stand, right sided weakness, and lingual nerve damage requiring feedings through a gastrostomy tube. Subsequently, the patient experienced developmental delays and hormonal issues.
