# Adult Medulloblastoma Presenting With Audiovestibular Symptoms and an Alternating Unterberger Test

## TL;DR

An adult with medulloblastoma showed unusual audiovestibular symptoms instead of typical brain tumor signs.

## Contribution

This case report highlights atypical presentation of adult medulloblastoma with prolonged audiovestibular symptoms.

## Key findings

- Adult medulloblastoma can present with audiovestibular symptoms instead of typical neurological signs.
- The tumor was located in the fourth ventricle and was histologically confirmed as CNS WHO Grade 4.
- The patient relapsed after treatment, showing spinal metastases.

## Abstract

A man in his 30s presented with a four-week history of vertigo, unilateral tinnitus, and nausea on a background of a three-year history of asymmetric audiovestibular symptoms attributed to peripheral vestibular pathology. The neurological examination was normal. A brain magnetic resonance imaging (MRI) demonstrated a fourth ventricular enhancing tumour, which was resected. The final histology was classical medulloblastoma CNS WHO Grade 4. He received craniospinal irradiation and adjuvant chemotherapy. Two years after treatment, he relapsed with spinal drop metastases and received palliative treatment. This case highlights that adults with medulloblastoma may present atypically with a longer history of unusual audiovestibular symptoms rather than signs of raised intracranial pressure or brainstem/cerebellar dysfunction.