title: Pathological crying and emotional vasovagal syncope as symptoms of a dorsally exophytic medullary tumor.
abstract: A 3-year-old boy with a dorsally exophytic tumor arising from the rostral medulla presented with a chief complaint of a change in his emotional behavior, most notably anxiety and paroxysmal crying often followed by syncope. Magnetic resonance imaging revealed that the tumor pushed on the dorsal surface of the medulla and displaced the medulla anteriorly, and also displaced the cerebellar vermis upward and slightly posteriorly. Tissue from a partial resection was diagnosed as a pilocytic astrocytoma. The symptoms did not improved after surgery, but did improve clinically after chemotherapy with vincristine and carboplatin, at which time MR showed a reduction in tumor size. We diagnosed the paroxysmal crying as 'pathological crying' and the syncope with increased anxiety as 'emotional vasovagal syncope'. This case stresses the importance of recognition of this rare presentation as an indication of a medullary tumor.
authors.affiliation: Department of Pediatrics and Child Health, Kurume University School of Medicine, Japan.
authors.forename: Kotaro
authors.initials: K
authors.lastname: Yuge
authors.affiliation: Department of Pediatrics and Child Health, Kurume University School of Medicine, Japan. Electronic address: ohya@med.kurume-u.ac.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Ohya
authors.affiliation: Department of Pediatrics and Child Health, Kurume University School of Medicine, Japan.
authors.forename: Ikuhiko
authors.initials: I
authors.lastname: Shibuya
authors.affiliation: Department of Pediatrics and Child Health, Kurume University School of Medicine, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Nagamitsu
authors.affiliation: Department of Pediatrics and Child Health, Kurume University School of Medicine, Japan.
authors.forename: Yushiro
authors.initials: Y
authors.lastname: Yamashita
mesh_terms: D001254:Astrocytoma / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology; D020295:Brain Stem Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003448:Crying / Q000502:physiology; D003937:Diagnosis, Differential; D004569:Electroencephalography; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D019462:Syncope, Vasovagal / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy
keywords: Brainstem tumor; Dorsal medulla; Emotional vasovagal syncope; Pathological crying