title: Diurnally fluctuating frontal dysequilibrium secondary to a pineal pilocytic astrocytoma: is this symptom associated with a check-valve mechanism in a pineal region tumor?
abstract: BACKGROUND
  The clinical manifestations of obstructive hydrocephalus vary with the age of the patient, duration of the condition, and etiology of the hydrocephalus.
  
  
  METHODS
  A 14-year-old boy presented with diurnally fluctuating dysarthria, dysequilibrium of the gait, and retropulsion, probably due to transient obstruction by a tumor at the entrance of the cerebral aqueduct of the pineal region. This fluctuation was ascertained clinically by assessing the ICARS score 5 h after the patient was in the supine and erect positions.
  
  
  CONCLUSIONS
  This result suggests that the symptoms of hydrocephalus are possibly associated with a check-valve mechanism of the pineal tumor and may be related to transient compression of the basal ganglia and frontal lobes.
authors.affiliation: Department of Neurology, The Catholic University of Korea, Seoul, Korea.
authors.forename: Tae-Won
authors.initials: TW
authors.lastname: Kim
authors.forename: Tae-Kyu
authors.initials: TK
authors.lastname: Lee
authors.forename: Bum-Soo
authors.initials: BS
authors.lastname: Kim
authors.forename: Kwang-Soo
authors.initials: KS
authors.lastname: Lee
authors.forename: In-Uk
authors.initials: IU
authors.lastname: Song
authors.forename: Joong-Seok
authors.initials: JS
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D001254:Astrocytoma / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D002555:Cerebrospinal Fluid; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology* / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D010870:Pineal Gland / Q000473:pathology*; D010871:Pinealoma / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D015173:Supratentorial Neoplasms / Q000150:complications* / Q000473:pathology / Q000503:physiopathology