HG-90: UNUSUAL CLINICAL COURSE OF TECTAL PLATE GLIOMA IN 10 YEAR OLD BOY

Tectal plate glioma is a specific entity and a quite rare condition in children. It usually has an indolent clinical course and a good prognosis. In most cases initial symptoms are caused by hypertensive hydrocephalus after an episode of headache and vomiting. Children diagnosed with tectal glioma require radiological follow up with a typical finding for a low grade glioma and different pattern of contrast enhancement. Additionally, tumor can cause partial complex seizures, EEG changes and oculomotor abnormalities. We report a case report of a 10 year old boy with tectal glioma that had a typical initial presentation (hypertensive hydrocephalus resolved with VP shunt) and an indolent clinical course for 1 year as shown on subsequent MRI scans. Thereafter, within two weeks he developed signs of progressive neurological impairment - ocularpalsy described as syndrome Parinaud and status epilepticus with progression of disturbance of consciousness resulting in coma vigile. Although there was no significant tumor volume progression nor dysfunction of VP shunt, the pattern of contrast enhancement was extremely increased. After performing an endoscopic biopsy, boy was diagnosed with glioblastoma. Conclusively, although most tectal plate tumors are considered low grade glioma with indolent clinical course close follow up is warranted.