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Title

Torticollis, photophobia and epiphora secondary to fossa posterior tumour: a case report

Purpose	To indicate that a pilocytic astrocytoma in the posterior cranial fossa in children is one of the causes of torticollis with epiphora and photophobia. To illustrate the value of an MRI scan of the brain in making this diagnosis.
Methods	Case report
Results	We describe the case of an eight-month-old girl who presented with a triad of photophobia and epiphora since birth with a pronounced progressive torticollis with a head turn to the right and a chin tilt downwards. The eye examination was unremarkable with the exception of a slightly paler fundus. There was no nystagmus. Neurological examination revealed a normal, albeit asymmetrical development with reduced unilateral grasping and failure to thrive. A brain CT scan did not show any substantial abnormalities. MRI of the brain revealed a posterior fossa tumour. The tumour is mainly hyperintense on T2, and hypo-intense on T1. Biopsy and debulking of the tumour were performed with subtotal excision. Histopathology was typical of a pilocytic astrocytoma. With more than 95% of the lesion resected without damage to either medulla oblongata or brain stem, and in view of the histopathological findings, no further surgery or chemotherapy was performed. The torticollis improved, the child thrived better, but photophobia remained.
Conclusion	The triad of photophobia, epiphora and torticollis should suggest a posterior fossa tumour. In infants with these symptoms an MRI rather than a CT brain is the examination of choice.

Author 1

Last name	DAUWE
Initials	C
Department	Dept of Ophthalmology, Ghent University Hospital
City	Ghent

Author 2

Last name	VERLOOY
Initials	J
Department	Dept of Paediatric Oncology, Ghent University Hospital
City	Ghent

Author 3

Last name	DELBEKE
Initials	P
Department	Dept of Ophthalmology, Ghent University Hospital
City	Ghent