The usual presenting symptoms of medulloblastoma are headache, vomiting and ataxia [
2,
4]. Although CSF dissemination to the cranio-spinal axis can happen in 30% to 40% of cases, initial presentation with spinal cord compression is quite rare [
1,
2,
5]. Pezeshkpour and colleagues analyzed more than 18,000 primary central nervous system tumors and found that only 0.01% of them had drop spinal metastasis, which had caused the presenting symptoms [
6]. At the time of diagnosis around 10% to 35% of the cases had extra-medullary intradural metastasis, however, their main presenting symptoms were due to the primary intracranial tumor [
3]. In 1986, Wang
et al., reported the case of a 28-year-old woman with thoracic extra-medullary medulloblastoma metastasis causing her to have progressive weakness as the initial presenting symptoms (Table
1) [
7]. More recently, Lee and colleagues from China described a case with acute paraplegia caused by drop spinal metastasis [
8]. Stanley and colleagues, in 1988, reported on 34 patients with medulloblastoma [
5]. Fifteen of those had a positive result on myelogram for spinal metastasis and only one patient suffered from lower limb weakness related to spinal pathology; however, it was not the initial presenting symptom. Our group, in 1996, reported on the outcomes of 149 patients who received treatment at our institution. None of those had presented initially with symptoms related to spinal metastasis at time of diagnosis [
9]. Two adult patients have been reported in non-English language articles: one with cauda equine syndrome and the other with radiculitis features as the presenting clinical features of medulloblastoma [
10,
11].
Table 1
Selected reported cases of cauda equine syndrome as the main initial presenting clinical features
| 28 years | Male | Progressive lower limb weakness |
Alla [ 11] (article in French) | 64 years | Male | Radiculitis features followed by cauda equina syndrome features |
| 4 years | Female | Cauda equina syndrome features (lower limb weakness and urinary retention) |
Present case report | 3 years | Male | Cauda equina syndrome features |
However, spinal intramedullary metastasis of medulloblastoma rarely occurs. To date, there have been a limited number of cases with spinal intramedullary metastasis reported in the literature [
12‐
14]. Zumpano, in 1978, reported on a patient with intramedullary metastatic medulloblastoma several weeks after resecting the posterior fossa tumor [
12]. Subsequently, a similar case was described by Stanley
et al. in 1986 [
5]. Recently, Inoue and colleagues reported on a child who had progressive weakness as the initial presenting features for intramedullary spinal metastasis [
14]. In general, medulloblastoma spinal metastasis varied from nodular lesions to complete spinal block [
5]. Our patient had extramedullary nodules, leptomeningeal enhancement and spinal block at the lumbar region. The cranial MRI findings were of sufficient importance to alter the management of our patient and to pave the way for different treatment strategies.