An unusual presentation of posterior fossa ependymoma in a child.

To cite: Crawford JR, Newbury RO, Friedman JR. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2013-010267 DESCRIPTION A 15-year-old girl with a history of congenital nystagmus presented with newly recognised hyperkinetic tongue movements on protrusion without dysphagia, dysphonia or palatal myoclonus (see online supplementary video). Contrast-enhanced MRI revealed a small lesion within the fourth ventricle abutting the dorsal medulla (figure 1). The pathology on gross total resection demonstrated a hypercellular tumour with areas of perivascular pseudorosettes consistent with a diagnosis of ependymoma (figure 2). The tongue movements did not subside following resection, indicative of possible residual infiltrative neoplasm and unlikely functional disorder. Whereas tongue tremor has been reported as a consequence of progression or treatment of glioma, 2 this case highlights the association of hyperkinetic tongue movements as a possible presenting feature of posterior fossa ependymoma.