Diurnally fluctuating frontal dysequilibrium secondary to a pineal pilocytic astrocytoma: Is this symptom associated with a check-valve mechanism in a pineal region tumor?

Introduction: The clinical manifestations of obstructive hydrocephalus vary with the age of the patient, duration of the condition, and etiology of the hydrocephalus. Case report: 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. Conclusion: 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.