Differentials
Migraine
SIGNS / SYMPTOMS
Family history of migraine.
Aura may be present.
Headache does not occur daily and is not worse in the morning.
INVESTIGATIONS
Neuroimaging of the brain will be normal.
Viral infection
SIGNS / SYMPTOMS
Sick contacts at home or school.
Associated with fever, myalgias, arthralgias, diarrhoea, or rhinorrhoea.
Vomiting not just in the morning; symptoms do not improve after vomiting.
INVESTIGATIONS
Blood work shows elevated WBC count.
Neuroimaging of the brain will be normal.
Ependymoma
SIGNS / SYMPTOMS
Ataxia more common.
INVESTIGATIONS
Tumour in region of foramen of Luschka on MRI.
Calcifications on brain CT.[32]
Biopsy of lesion confirms diagnosis.
Juvenile pilocytic astrocytoma
SIGNS / SYMPTOMS
Presents similarly, with signs and symptoms of obstructive hydrocephalus.
Fibrillary astrocytoma
SIGNS / SYMPTOMS
Presents similarly, with signs and symptoms of obstructive hydrocephalus.
INVESTIGATIONS
Originating in the cerebellar hemisphere and not growing into or filling the fourth ventricle on neuroimaging, but can be effacing the ventricle, an important distinction.[32]
Biopsy of lesion confirms diagnosis.
Ganglioglioma
SIGNS / SYMPTOMS
Presents similarly, with signs and symptoms of obstructive hydrocephalus.
INVESTIGATIONS
Originating in the cerebellar hemisphere and not growing into or filling the fourth ventricle on neuroimaging, but can be effacing the ventricle, an important distinction.[32]
Biopsy of lesion confirms diagnosis.
Atypical teratoid/rhabdoid tumour
SIGNS / SYMPTOMS
Very difficult to distinguish from medulloblastoma. Presents similarly, with signs and symptoms of obstructive hydrocephalus.
INVESTIGATIONS
Originating in the cerebellar vermis and growing into and filling the fourth ventricle on neuroimaging.[32]
Very difficult to distinguish from medulloblastoma.
Similar histology to medulloblastoma; however, immunohistochemistry will show absence of staining for the product of the tumour suppressor gene INI-1.
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