Rare central neurocytoma in fourth ventricle: A case report with intratumoral hemorrhage and cerebellar mutism syndrome

Objective

Central neurocytoma (CN) is a rare benign tumor usually found in the lateral and third ventricles. This report highlights an exceptional case of CN in the fourth ventricle, leading to acute hydrocephalus due to bleeding. The patient later developed cerebellar mutism syndrome (CMS), a rare condition following posterior fossa surgery. We retrospectively analyzed data from a patient who experienced sudden loss of consciousness due to hemorrhagic fourth ventricular CN.

Case presentation

A 43-year-old male presented with sudden loss of consciousness. Initial computed tomography (CT) scan revealed a large left cerebellar hemorrhagic lesion causing hydrocephalus. An external ventricular drainage catheter was inserted to alleviate hydrocephalus, followed by emergent surgery to address the mass. A second surgery was needed due to rebleeding, achieving complete tumor removal. A ventriculoperitoneal shunt was inserted for permanent hydrocephalus management. Post-surgery, the patient presented with significant neurological symptoms, including muteness, ataxia, and hypotonia, which improved with medical treatment involving fluoxetine and bromocriptine. A one-year follow-up magnetic resonance imaging (MRI) confirmed successful tumor removal with no signs of recurrence.

Conclusion

This case emphasizes the unusual occurrence of CN in the fourth ventricle with bleeding and the possibility of CMS in adult patients after posterior fossa surgery.