Incidental Subependymoma of the Floor of the Fourth Ventricle: A Case Report

TL;DR

A young woman with unusual sensory symptoms was found to have a rare brain tumor, which was safely managed without surgery.

Contribution

This case highlights the importance of early MRI in young adults with atypical symptoms and shows that small subependymomas can be safely observed.

Findings

The patient's sensory symptoms resolved without intervention, and the tumor remained stable on follow-up imaging.

Conservative management of small, non-obstructive fourth-ventricle subependymomas can lead to excellent short-term outcomes.

Incidental subependymomas may present with unusual symptoms like migratory paresthesias, not just fluid obstruction.

Abstract

Subependymomas are rare, slow-growing intraventricular tumors that are typically discovered incidentally and seldom present with transient sensory symptoms in young adults. We report the case of a 22-year-old woman who presented with episodic migratory paresthesias and was found on brain MRI to have a small fourth-ventricular lesion radiographically consistent with subependymoma. The patient’s sensory symptoms resolved spontaneously, and no further episodes occurred. Conservative management with serial imaging was pursued. At the six-month follow-up, the lesion remained stable, and the patient was asymptomatic. Subependymomas most commonly become symptomatic due to cerebrospinal fluid obstruction, whereas episodic migratory paresthesias are unusual. This case highlights the value of early MRI in young adults with atypical sensory symptoms, which may reveal incidental yet clinically significant findings and help avoid unnecessary invasive testing. Small, non-obstructive fourth-ventricle subependymomas can be safely managed with observation, demonstrating excellent short-term clinical and radiographic outcomes.

Figures