Acute-Onset Neurological Symptoms in a Child with a Large Solid-Cystic Brain Tumor: A Case Report

Introduction: Pediatric brain tumors often present with nonspecific symptoms, leading to diagnostic delays. Case Presentation: A 4-year-old girl presented with intermittent headaches, left-hand tremors, left-sided weakness, and vomiting. Neurological examination revealed left hemiparesis and central facial nerve palsy. Brain MRI demonstrated a 10 cm supratentorial solid-cystic mass with calcifications, necrosis, mass effect, and mild obstructive hydrocephalus. Advanced imaging, including MR spectroscopy and SWI, suggested differential diagnoses of high-grade glioma, DNET, or ganglioglioma. A craniotomy and tumor biopsy were performed, with histopathological analysis indicating possible astrocytoma, ependymoma, or astroblastoma. On postoperative day three, the patient developed a focal motor seizure, which was successfully controlled. A multidisciplinary team managed the patient with antibiotics, corticosteroids, antiepileptics, supportive therapy, and early rehabilitation. At present, the patient is neurologically stable with no deficits and is undergoing chemotherapy following a low-grade glioma protocol (cisplatin, etoposide, vincristine, and carboplatin) while awaiting final immunohistochemical confirmation. Conclusion: Early neuroimaging, including advanced MRI techniques, is critical for accurate diagnosis and prompt surgical intervention in pediatric brain tumors. Comprehensive care—including histopathology, immunohistochemistry, systemic therapy, and multidisciplinary support—plays a vital role in optimizing outcomes and improving the quality of life for affected children.