Rare Haemangioblastoma Presentation

A young lady in her 30s was admitted to hospital via the emergency department following investigatory MRI. Ms W had previously been involved in a high-speed motor vehicle accident many years prior, suffering numerous symptoms including headache, neck pain, vestibular symptoms and a PTSD diagnosis. Serial cranial imaging over time demonstrated a right posterior fossa nodule/cyst for which surgical review was recommended.

Due to various circumstances, the patient did not undergo review at the recommended time and re-presented to her neurologist with worsening balance symptoms. At the time of consultation, Ms W demonstrated nystagmus (involuntary eye movement) and balance disturbance indicating the need for an MRI. This scan demonstrated a 14mm enhancing nodule in the anterior right cerebellar hemisphere associated with a large cyst causing considerable fourth ventricle/brainstem compression and associated hydrocephalus. Ms W was referred to emergency following the scan and subsequently admitted to hospital.

The MRI findings were typical of a solid haemangioblastoma nodule with an associated cyst. Surgery was performed semi-urgently due to worsening symptoms. A gross total resection of the solid nodule was undertaken and the associated cyst was drained.

Histology confirmed haemangioblastoma. Haemangioblastomas are rare benign brain tumours that start in the cells that line the blood vessels in the brain, spinal cord and brain stem. They are slow growing, often over years, and commonly start in the back of the brain.

Ms W recovered well from the surgery and neurological symptoms resolved. No further treatment is planned.