Isolated complete oculomotor nerve palsy as a presentation of adult medulloblastoma

A 37-year-old man presented with isolated complete oculomotor nerve palsy, without other neurological signs. Magnetic resonance imaging (MRI) showed thickening and enhancement of the left third cranial nerve, along with a small nodular lesion in the right cerebellar hemisphere with diffusion restriction ([Figure 1]). Repeated cerebrospinal fluid analysis eventually confirmed the presence of neoplastic cells. Resection of the cerebellar lesion revealed desmoplastic/nodular-type medulloblastoma (MB), sonic hedgehog (SHH)-activated, and TP53 wildtype. The patient was treated with neuroaxis radiotherapy and adjuvant chemotherapy. This case demonstrates a rare presentation of adult MB, highlighting the importance of considering leptomeningeal dissemination in the differential diagnosis of isolated cranial neuropathies.[1] [2] [3] [4]

Figure 1 Magnetic resonance scan of the brain of the patient with medulloblastoma and cerebrospinal fluid dissemination. (A) Coronal and (B) Axial T1-weighted SE after gadolinium (Gd) shows thickening and contrast enhancement of the left oculomotor nerve (arrow). (C) Axial T1-weighted SE after Gd reveals a nodular lesion in the lower medial region of the right hemisphere of the cerebellum (arrow). (D) Axial DWI B1000 sequence shows restricted diffusion in the nodular lesion (arrow).

Authors Contributions

Conceptualization: RTNL, BGG, MSC, SBAN, AJS; Data curation: RTNL, BGG, MSC, SBAN, AJS; Formal analysis: RTNL, BGG, MSC, SBAN, AJS; Validation: RTNL, BGG, MSC, SBAN, AJS; Visualization: RTNL, BGG, MSC, SBAN, AJS; Writing – original draft: RTNL, BGG, MSC, SBAN, AJS; Writing – review & editing: RTNL, BGG, MSC, SBAN, AJS; Investigation: RTNL, BGG, MSC, SBAN, AJS; Project administration: RTNL, BGG, MSC, SBAN, AJS; Resources: RTNL, BGG, MSC, SBAN, AJS; Visualization: RTNL, BGG, MSC, SBAN, AJS; Funding acquisition: MSC; Supervision: MSC.

Data Availability Statement

This study is a case report and, therefore, did not generate or analyze any dataset beyond the information included in the manuscript. Additional patient data (such as images or test results) are available upon request to the corresponding author, subject to ethical approval and patient consent.

Editor-in-Chief: Hélio A. G. Teive 0000-0003-2305-1073.

Associate Editor: Leandro Tavares Lucato 0000-0001-9181-5245.

Publikationsverlauf

Eingereicht: 18. März 2025

Angenommen: 17. April 2025

Artikel online veröffentlicht:
01. Juli 2025

• References

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