A 13-year-old boy presents with subacute headache and diplopia. Neurologic examination shows vertical gaze palsy and MRI shows a contrast-enhancing lesion in the pineal region obstructing the aqueduct of Sylvian. The most likely diagnosis is:
Diplopia is usually caused by acute or secondary strabismus. Vertical gaze palsy is due to a midbrain lesion. In this case the MRI already places the origin of the symptoms in the pineal gland. The most frequent tumor in this region is the germ cell tumor (answer 3).
Glioblastoma.
Medulloblastoma.
Germ cell tumor.
Meningioma.
In this case the MRI already places the origin of the symptoms in the pineal gland. The most frequent tumor in this region is the germ cell tumor (answer 3).