Clinical Manifestations Progressive headache – No history of infection – Lack of fever, GI and urinary problems – Unremarkable laboratory work-up – Increasing intensity, frequency, association with vomiting, unresponsive to medications – ↑ ICP secondary to an underlying tumor

Juvenile pilocytic astrocytoma – Localized signs and symptoms of cerebellar dysfunction Positive Romberg’s sign, intact motor strength, no gait disturbance Horizontal nystagmus, no auditory problems CT scan findings

– Others Headache Vomiting, with or without nausea No visual problems Anemia Hyperreflexia of the lower extremities No pathologic reflexes, supple neck