The fourth ventricle is enlarged by a tumour some 4 x 3 cm. The cerebellum and brain stem are
distorted and there is extensive haemorrhage posteriorly and in the subarachnoid space at the
base. The third ventricle is grossly dilated and there is a moderate degree of dilatation of the
lateral ventricles. The convolutions of the cerebellum are flattened.
This 2-year-old child had become listless and stopped talking except in monosyllables
over the previous three months. Her muscles were hypotonic and floppy. She became more and
more drowsy and developed an intermittent sixth nerve palsy with progressively more feeble
respiration. Examination and subsequent surgery determined the presence of an ependymoma
in the fourth ventricle. The child died postoperatively.